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General NPI Number Information
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NPI Number | 1972959252
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Entity Type | Individual
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Provider Name | CRYSTAL WATKINS MS, LPC, LMHC
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Gender | Female
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Dates
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Enumeration Date | 05/05/2016
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Last Update Date | 02/20/2024
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Provider Practice Location Address
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Address Line | 315 W PONCE DE LEON AVE STE 546
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City | DECATUR
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State | GA
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Zip | 30030-2448
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Country | US
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Telephone | 478-320-1576
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Fax |
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Provider Business Mailing Address
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Address Line | 114 BRUTON ST
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City | DECATUR
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State | GA
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Zip | 30030-3767
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Country | US
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Telephone | 478-320-1576
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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 | LPC008807
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 9113551
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License Number State | NY
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