Provider Demographics
NPI:1174262448
Name:WATTS, RACHELLE (RBT)
Entity Type:Individual
Prefix:
First Name:RACHELLE
Middle Name:
Last Name:WATTS
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3525 US HIGHWAY 17
Mailing Address - Street 2:
Mailing Address - City:FLEMING ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32003-7122
Mailing Address - Country:US
Mailing Address - Phone:352-317-0701
Mailing Address - Fax:
Practice Address - Street 1:3525 US HIGHWAY 17
Practice Address - Street 2:
Practice Address - City:FLEMING ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32003-7122
Practice Address - Country:US
Practice Address - Phone:352-317-0701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-03
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLRBT-21-192173Medicaid