Provider Demographics
NPI:1558683656
Name:WATSON, KANDY MICHELLE (BA)
Entity Type:Individual
Prefix:
First Name:KANDY
Middle Name:MICHELLE
Last Name:WATSON
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:KANDY
Other - Middle Name:MICHELLE
Other - Last Name:YOUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:44443 10TH ST W
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-3346
Mailing Address - Country:US
Mailing Address - Phone:661-726-2630
Mailing Address - Fax:661-726-2630
Practice Address - Street 1:44443 10TH ST W
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-3346
Practice Address - Country:US
Practice Address - Phone:661-726-2630
Practice Address - Fax:661-726-2630
Is Sole Proprietor?:No
Enumeration Date:2010-02-17
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health