Provider Demographics
NPI:1235870692
Name:WATSON, KATHRYN (LMSW)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:WATSON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3820 OAK HILL RD
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30135-5022
Mailing Address - Country:US
Mailing Address - Phone:404-725-4617
Mailing Address - Fax:
Practice Address - Street 1:22 CENTURY BLVD STE 220
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37214-3787
Practice Address - Country:US
Practice Address - Phone:470-453-7728
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-07
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMSW009100104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker