Provider Demographics
NPI:1639628506
Name:WATSON, CARL
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:
Last Name:WATSON
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 1:1120 W BUTLER RD
Mailing Address - Street 2:SUITE M
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-4845
Mailing Address - Country:US
Mailing Address - Phone:864-412-8275
Mailing Address - Fax:
Practice Address - Street 1:1120 W BUTLER RD
Practice Address - Street 2:SUITE M
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-4845
Practice Address - Country:US
Practice Address - Phone:864-412-8275
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-03
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor