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General NPI Number Information
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NPI Number | 1942516513
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Entity Type | Individual
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Provider Name | GINA MARIE WATKINS LCSW, LICSW
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Gender | Female
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Dates
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Enumeration Date | 08/20/2010
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 1409 FRANKLIN ST STE 103
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City | VANCOUVER
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State | WA
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Zip | 98660-2860
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Country | US
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Telephone | 720-253-6783
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Fax |
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Provider Business Mailing Address
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Address Line | 5609 NW 8TH AVE
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City | VANCOUVER
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State | WA
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Zip | 98663-1678
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Country | US
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Telephone | 720-253-6783
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | L6072
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LW60691560
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License Number State | WA
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