Provider Demographics
NPI:1467841841
Name:WATFORD, ALETHIA NICOLE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ALETHIA
Middle Name:NICOLE
Last Name:WATFORD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:ALETHA
Other - Middle Name:NICOLE
Other - Last Name:WATFORD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:969 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23223-5944
Mailing Address - Country:US
Mailing Address - Phone:804-334-1005
Mailing Address - Fax:
Practice Address - Street 1:969 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23223-5944
Practice Address - Country:US
Practice Address - Phone:804-334-1005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-22
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040078011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical