Provider Demographics
NPI:1538462254
Name:WATKINS, KIMATIA SHAUNTEL (LPCA, NCC, LCMHC)
Entity Type:Individual
Prefix:MRS
First Name:KIMATIA
Middle Name:SHAUNTEL
Last Name:WATKINS
Suffix:
Gender:F
Credentials:LPCA, NCC, LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 E WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-2957
Mailing Address - Country:US
Mailing Address - Phone:336-333-6853
Mailing Address - Fax:
Practice Address - Street 1:301 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-2957
Practice Address - Country:US
Practice Address - Phone:336-333-6853
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-20
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA8501101YP2500X
NC8501101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health