Provider Demographics
NPI:1326301417
Name:WATSON, KEISHA M (MS, LCPC, NCC)
Entity Type:Individual
Prefix:MRS
First Name:KEISHA
Middle Name:M
Last Name:WATSON
Suffix:
Gender:F
Credentials:MS, LCPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6710A ROCKLEDGE DR STE 400
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-2847
Mailing Address - Country:US
Mailing Address - Phone:240-255-3295
Mailing Address - Fax:240-255-3295
Practice Address - Street 1:6710A ROCKLEDGE DR STE 400
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817-2847
Practice Address - Country:US
Practice Address - Phone:240-255-3295
Practice Address - Fax:240-255-3297
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-22
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC3899101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD054678000Medicaid