Provider Demographics
NPI:1003968827
Name:WATERMAN, DONALD JAMES JR (PHD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:JAMES
Last Name:WATERMAN
Suffix:JR
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5001 HIGHWAY 190 EAST SERVICE RD STE C1
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-4949
Mailing Address - Country:US
Mailing Address - Phone:985-626-8700
Mailing Address - Fax:985-892-2055
Practice Address - Street 1:5001 HIGHWAY 190 EAST SERVICE RD STE C1
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-4949
Practice Address - Country:US
Practice Address - Phone:985-626-8700
Practice Address - Fax:985-892-2055
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2604101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health