Provider Demographics
NPI:1063673531
Name:WATKINS, MADELINE CHRISTINA (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:MADELINE
Middle Name:CHRISTINA
Last Name:WATKINS
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:MADELINE
Other - Middle Name:CHRISTINA
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:616 E COLFAX
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46617
Mailing Address - Country:US
Mailing Address - Phone:574-532-2755
Mailing Address - Fax:
Practice Address - Street 1:616 E COLFAX
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46617
Practice Address - Country:US
Practice Address - Phone:574-532-2755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-18
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39001909A101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor