Provider Demographics
NPI:1033264452
Name:WATSON-CUELLAR, KARA ANN (LCAS, LPCA)
Entity Type:Individual
Prefix:
First Name:KARA
Middle Name:ANN
Last Name:WATSON-CUELLAR
Suffix:
Gender:F
Credentials:LCAS, LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1116 GREENWOOD CLFS
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204-2821
Mailing Address - Country:US
Mailing Address - Phone:704-334-0524
Mailing Address - Fax:980-209-9757
Practice Address - Street 1:1116 GREENWOOD CLFS
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204
Practice Address - Country:US
Practice Address - Phone:704-334-0524
Practice Address - Fax:980-209-9757
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2117101YA0400X
NCA11547101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2117Medicaid