Provider Demographics
NPI:1033241484
Name:WATSON, KENNETH LAMONT (MS, CADC)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:LAMONT
Last Name:WATSON
Suffix:
Gender:M
Credentials:MS, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1423 KIRKWOOD HIGHWAY & POLLY DRUMMOND RD
Mailing Address - Street 2:BUILDING 3
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19701
Mailing Address - Country:US
Mailing Address - Phone:302-454-7520
Mailing Address - Fax:302-454-7524
Practice Address - Street 1:1423 KIRKWOOD HIGHWAY & POLLY DRUMMOND RD
Practice Address - Street 2:SUITES 3304 &3305
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19701
Practice Address - Country:US
Practice Address - Phone:302-454-7520
Practice Address - Fax:302-454-7524
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE498 CADC101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEDCB 498OtherCADC