MEDICARE: MS. TYIESHA KAY WATKINS LCSWA

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	P015840	NC

General Provider Information

NPI Number	:	1548634819
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TYIESHA KAY WATKINS LCSWA

Provider Business Mailing Address
First Line	:	11522 ELMIRA AVE APT 206
Second Line	:
City	:	HUNTERSVILLE
State	:	NC
Zip	:	28078-7228
Country	:	US
Telephone Number	:	910-995-5962
Fax Number	:

Provider Business Practice Location Address
First Line	:	1913 J N PEASE PL STE 101
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28262-4537
Country	:	US
Telephone Number	:	980-308-4500
Fax Number	:

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

Provider Enumeration Date	:	11/24/2015
Last Update Date	:	10/29/2024

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