Provider Demographics
NPI:1619164217
Name:WATTS, EVA JANE (MSW,LCSW,CSAC)
Entity Type:Individual
Prefix:
First Name:EVA
Middle Name:JANE
Last Name:WATTS
Suffix:
Gender:F
Credentials:MSW,LCSW,CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4715 PENNOAK RD
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27407-4029
Mailing Address - Country:US
Mailing Address - Phone:336-638-8136
Mailing Address - Fax:
Practice Address - Street 1:4715 PENNOAK RD
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-4029
Practice Address - Country:US
Practice Address - Phone:336-638-8136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-27
Last Update Date:2007-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2060101YA0400X
NCC005802101YM0800X, 104100000X, 1041C0700X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No251S00000XAgenciesCommunity/Behavioral Health