Provider Demographics
NPI:1205371002
Name:WATSON, MOLLY KATHLEEN (ASW)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:KATHLEEN
Last Name:WATSON
Suffix:
Gender:F
Credentials:ASW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3870 CRESTSTONE PL
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-1502
Mailing Address - Country:US
Mailing Address - Phone:760-405-3444
Mailing Address - Fax:
Practice Address - Street 1:1012 MAIN ST
Practice Address - Street 2:STE 101
Practice Address - City:RAMONA
Practice Address - State:CA
Practice Address - Zip Code:92065-2170
Practice Address - Country:US
Practice Address - Phone:760-788-9724
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-03
Last Update Date:2017-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health