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General NPI Number Information
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NPI Number | 1811038961
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Entity Type | Individual
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Provider Name | STEPHANIE M. WATSON MAMFC, LPCI
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Gender | Female
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Dates
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Enumeration Date | 02/10/2007
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Last Update Date | 11/15/2010
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Provider Practice Location Address
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Address Line | 5611 HIGHWAY 80 E
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City | PEARL
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State | MS
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Zip | 39208-8929
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Country | US
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Telephone | 601-939-6634
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Fax |
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Provider Business Mailing Address
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Address Line | 512 WINDSOR DR
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City | BRANDON
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State | MS
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Zip | 39047-7770
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Country | US
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Telephone | 601-992-7071
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 4781
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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