Provider Demographics
NPI:1568934842
Name:WATSON, WINTER SHANELLE (LCSWA)
Entity Type:Individual
Prefix:
First Name:WINTER
Middle Name:SHANELLE
Last Name:WATSON
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27565-2717
Mailing Address - Country:US
Mailing Address - Phone:919-690-5018
Mailing Address - Fax:
Practice Address - Street 1:600 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:NC
Practice Address - Zip Code:27565-2717
Practice Address - Country:US
Practice Address - Phone:919-690-5018
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-26
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0123161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical