Provider Demographics
NPI:1336472026
Name:POTIER WATTS, VANESSA M (LCSW)
Entity Type:Individual
Prefix:MS
First Name:VANESSA
Middle Name:M
Last Name:POTIER WATTS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:VANESSA
Other - Middle Name:
Other - Last Name:WATTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3104 O ST # 189
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-6519
Mailing Address - Country:US
Mailing Address - Phone:916-405-3499
Mailing Address - Fax:
Practice Address - Street 1:9093 ELK GROVE BLVD
Practice Address - Street 2:SUITE #206
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95624-2047
Practice Address - Country:US
Practice Address - Phone:916-405-3499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-12
Last Update Date:2009-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA254381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical