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General NPI Number Information
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NPI Number | 1861792202
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Entity Type | Individual
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Provider Name | ALFONZO WATKINS MSE, LPC
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Gender | Male
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Dates
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Enumeration Date | 11/02/2010
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Last Update Date | 11/02/2010
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Provider Practice Location Address
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Address Line | 1230 E AUER AVE SUITE 211 THE WAKE UP PROGRAM LLC
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City | MILWAUKEE
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State | WI
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Zip | 53212-2257
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Country | US
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Telephone | 414-372-4483
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Fax | 414-372-4483
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Provider Business Mailing Address
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Address Line | 1230 E AUER AVE SUITE 211 THE WAKE UP PROGRAM LLC
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City | MILWAUKEE
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State | WI
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Zip | 53212-2257
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Country | US
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Telephone | 414-372-4483
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Fax | 414-372-4483
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | LPC 3748-125
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License Number State | WI
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