Provider Demographics
NPI:1063033074
Name:JEFFERSON-WATKINS, MARCY RENEE (ALC)
Entity Type:Individual
Prefix:
First Name:MARCY
Middle Name:RENEE
Last Name:JEFFERSON-WATKINS
Suffix:
Gender:F
Credentials:ALC
Other - Prefix:
Other - First Name:MARCIE
Other - Middle Name:JEFFERSON
Other - Last Name:WATKINS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ALC
Mailing Address - Street 1:1953 S BROWNSTONE CT SW
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35603-2025
Mailing Address - Country:US
Mailing Address - Phone:256-476-0679
Mailing Address - Fax:
Practice Address - Street 1:2126 6TH AVE SE STE 208
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601-6547
Practice Address - Country:US
Practice Address - Phone:256-924-0553
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-30
Last Update Date:2020-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3248101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional