Provider Demographics
NPI:1235991654
Name:WATKINS, JUDY ANN
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:ANN
Last Name:WATKINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 ORANGE AVE UNIT B
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-5937
Mailing Address - Country:US
Mailing Address - Phone:209-480-2377
Mailing Address - Fax:
Practice Address - Street 1:1116 ALICE ST
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-5905
Practice Address - Country:US
Practice Address - Phone:209-578-3132
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-30
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)