Provider Demographics
NPI:1447618657
Name:WATKINS, RICHARD JR (MS, LCAS-A)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:WATKINS
Suffix:JR
Gender:M
Credentials:MS, LCAS-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1380 HERITAGE POINTE DR APT 106
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27127-6098
Mailing Address - Country:US
Mailing Address - Phone:336-306-0804
Mailing Address - Fax:
Practice Address - Street 1:1380 HERITAGE POINTE DR APT 106
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27127-6098
Practice Address - Country:US
Practice Address - Phone:336-306-0804
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-02
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3430-A101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)