Provider Demographics
NPI:1629483367
Name:WATKINS, MICHELE (MSW)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:WATKINS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 PIKE ST
Mailing Address - Street 2:P.O. BOX 1865
Mailing Address - City:DAYTON
Mailing Address - State:NV
Mailing Address - Zip Code:89403-6758
Mailing Address - Country:US
Mailing Address - Phone:775-246-0320
Mailing Address - Fax:775-246-7553
Practice Address - Street 1:170 PIKE ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:NV
Practice Address - Zip Code:89403-6758
Practice Address - Country:US
Practice Address - Phone:775-246-0320
Practice Address - Fax:775-246-7553
Is Sole Proprietor?:No
Enumeration Date:2014-06-20
Last Update Date:2015-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV752101YA0400X
NV6731-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)