Provider Demographics
NPI:1194393652
Name:WATSON, LAUREN EVANS (LPCA)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:EVANS
Last Name:WATSON
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 FARRS BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29617-1905
Mailing Address - Country:US
Mailing Address - Phone:864-383-0384
Mailing Address - Fax:864-568-3938
Practice Address - Street 1:205 FARRS BRIDGE RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29617-1905
Practice Address - Country:US
Practice Address - Phone:864-383-0384
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-11
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC301100Medicaid