Provider Demographics
NPI:1093853277
Name:WATTS, SUSAN DAIL (IMF)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:DAIL
Last Name:WATTS
Suffix:
Gender:F
Credentials:IMF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 GREGORY LN STE 33
Mailing Address - Street 2:(925) 827-9876
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-4915
Mailing Address - Country:US
Mailing Address - Phone:925-827-9876
Mailing Address - Fax:
Practice Address - Street 1:101 GREGORY LN STE 33
Practice Address - Street 2:(925) 827-9876
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-4915
Practice Address - Country:US
Practice Address - Phone:925-827-9876
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF51926101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health