Provider Demographics
NPI:1134309784
Name:WATSON, STEPHANIE DAUGHERTY (MSCC, LMHC)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:DAUGHERTY
Last Name:WATSON
Suffix:
Gender:F
Credentials:MSCC, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:448 SW DELAWARE WAY
Mailing Address - Street 2:
Mailing Address - City:FORT WHITE
Mailing Address - State:FL
Mailing Address - Zip Code:32038-4620
Mailing Address - Country:US
Mailing Address - Phone:386-438-0442
Mailing Address - Fax:
Practice Address - Street 1:448 SW DELAWARE WAY
Practice Address - Street 2:
Practice Address - City:FORT WHITE
Practice Address - State:FL
Practice Address - Zip Code:32038-4620
Practice Address - Country:US
Practice Address - Phone:386-438-0442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-13
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH13021101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health