Provider Demographics
NPI:1619264231
Name:WATSON, ALICIA SHAWNTA (MA, LPC,)
Entity Type:Individual
Prefix:MS
First Name:ALICIA
Middle Name:SHAWNTA
Last Name:WATSON
Suffix:
Gender:F
Credentials:MA, LPC,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 RIVER DR
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-4414
Mailing Address - Country:US
Mailing Address - Phone:704-449-3816
Mailing Address - Fax:
Practice Address - Street 1:320 PLEASANT HILL RD
Practice Address - Street 2:
Practice Address - City:GASTON
Practice Address - State:NC
Practice Address - Zip Code:27832-9511
Practice Address - Country:US
Practice Address - Phone:704-449-3816
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-03
Last Update Date:2019-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7729101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional