Provider Demographics
NPI:1194464206
Name:WATSON, WENDY LIZER (LBSW)
Entity Type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:LIZER
Last Name:WATSON
Suffix:
Gender:F
Credentials:LBSW
Other - Prefix:MS
Other - First Name:WENDY
Other - Middle Name:MICHELLE
Other - Last Name:LIZER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:90 DAFFODIL FARM RD
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-5349
Mailing Address - Country:US
Mailing Address - Phone:864-237-5686
Mailing Address - Fax:
Practice Address - Street 1:90 DAFFODIL FARM RD
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-5349
Practice Address - Country:US
Practice Address - Phone:864-237-5686
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-27
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC14394104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker