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General NPI Number Information
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NPI Number | 1689879140
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Entity Type | Individual
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Provider Name | WILLIE WATSON
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Gender | Male
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Dates
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Enumeration Date | 06/15/2007
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Last Update Date | 03/05/2008
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Provider Practice Location Address
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Address Line | 25 S OLD BALTIMORE PIKE LAFAYETTE BLDG. II, SUITE 400
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City | CHRISTIANA
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State | DE
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Zip | 19702-1540
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Country | US
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Telephone | 302-368-7453
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Fax |
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Provider Business Mailing Address
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Address Line | 5 CORDREY RD
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City | NEWARK
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State | DE
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Zip | 19713-2312
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Country | US
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Telephone | 302-368-4431
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | PC-0000409
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License Number State | DE
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