Provider Demographics
NPI:1568686954
Name:WATKINS, LEONARD W
Entity Type:Individual
Prefix:MR
First Name:LEONARD
Middle Name:W
Last Name:WATKINS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 S SUSSEX LANE #2
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38018
Mailing Address - Country:US
Mailing Address - Phone:901-246-3882
Mailing Address - Fax:
Practice Address - Street 1:1087 ALICE AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38106-6543
Practice Address - Country:US
Practice Address - Phone:901-259-1920
Practice Address - Fax:901-259-1922
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health