MEDICARE: ANGELA Q HARRIS-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	101Y00000X	Counselor
2	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1699414904
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA Q HARRIS-WATKINS

Provider Business Mailing Address
First Line	:	7941 CASTLEWAY DR
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46250-1953
Country	:	US
Telephone Number	:	513-482-1966
Fax Number	:

Provider Business Practice Location Address
First Line	:	77 E WOODBURY DR
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45415-2855
Country	:	US
Telephone Number	:	317-726-2121
Fax Number	:

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

Provider Enumeration Date	:	06/03/2022
Last Update Date	:	06/03/2022

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