MEDICARE: TA'WANE L WATKINS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	LG50081224	DC

General Provider Information

NPI Number	:	1134639693
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TA'WANE L WATKINS

Provider Business Mailing Address
First Line	:	1520 BELLE VIEW BLVD STE 5011
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22307-6530
Country	:	US
Telephone Number	:	202-933-9771
Fax Number	:	202-318-0667

Provider Business Practice Location Address
First Line	:	1520 BELLE VIEW BLVD # 5011
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22307-6530
Country	:	US
Telephone Number	:	202-933-9771
Fax Number	:	202-318-0667

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/10/2017
Last Update Date	:	05/19/2026

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