Provider Demographics
NPI:1275594582
Name:JEANNE WATSON
Entity Type:Organization
Organization Name:JEANNE WATSON
Other - Org Name:APPALACHIAN PSYCHOLOGICAL TRAUMA CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:JEANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:276-730-0548
Mailing Address - Street 1:PO BOX 100
Mailing Address - Street 2:
Mailing Address - City:HILLSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24343-0100
Mailing Address - Country:US
Mailing Address - Phone:276-730-0548
Mailing Address - Fax:276-730-0568
Practice Address - Street 1:408 N MAIN ST
Practice Address - Street 2:SUITE A
Practice Address - City:HILLSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24343-1435
Practice Address - Country:US
Practice Address - Phone:276-730-0548
Practice Address - Fax:276-730-0568
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701000999101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA087093MOtherSOUTHERN HEALTH
201692OtherVALUE OPTIONS
VA437317OtherANTHEM BC/BS