Provider Demographics
NPI:1467871079
Name:WATSON, AVERY ANISE (BSW, MSW, LCAS-A)
Entity Type:Individual
Prefix:MS
First Name:AVERY
Middle Name:ANISE
Last Name:WATSON
Suffix:
Gender:F
Credentials:BSW, MSW, LCAS-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5307 FIRELIGHT LN UNIT G
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28212-2210
Mailing Address - Country:US
Mailing Address - Phone:860-888-6058
Mailing Address - Fax:704-563-3353
Practice Address - Street 1:2301 RAMA RD
Practice Address - Street 2:SUIT B
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28212-6237
Practice Address - Country:US
Practice Address - Phone:860-888-6058
Practice Address - Fax:704-568-3353
Is Sole Proprietor?:No
Enumeration Date:2014-04-10
Last Update Date:2014-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20099101Y00000X, 101YA0400X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health