Provider Demographics
NPI:1376935809
Name:WATKINS, PHILIP ALLEN
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:ALLEN
Last Name:WATKINS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 FROG HOLLER LN
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04330-0453
Mailing Address - Country:US
Mailing Address - Phone:207-458-4403
Mailing Address - Fax:
Practice Address - Street 1:12 FROG HOLLER LN
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-0453
Practice Address - Country:US
Practice Address - Phone:207-458-4403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-20
Last Update Date:2015-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC525101YA0400X
MELP508101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)