Provider Demographics
NPI:1275960700
Name:WATSON-GRIFFIN, ANGIE LORRAINE (DSW, DAC, LCSW)
Entity Type:Individual
Prefix:DR
First Name:ANGIE
Middle Name:LORRAINE
Last Name:WATSON-GRIFFIN
Suffix:
Gender:F
Credentials:DSW, DAC, LCSW
Other - Prefix:MRS
Other - First Name:ANGIE
Other - Middle Name:LORRAINE
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DSW, LCSW
Mailing Address - Street 1:5902 DEERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:AR
Mailing Address - Zip Code:71854-8323
Mailing Address - Country:US
Mailing Address - Phone:318-404-4734
Mailing Address - Fax:
Practice Address - Street 1:2500 RIKE DR
Practice Address - Street 2:
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71603-3937
Practice Address - Country:US
Practice Address - Phone:870-534-1834
Practice Address - Fax:870-534-5798
Is Sole Proprietor?:No
Enumeration Date:2013-09-30
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28756101YA0400X
171M00000X
LA58831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1952846313Medicaid
AR278739719Medicaid