Provider Demographics
NPI:1669685483
Name:WATKINS, DAVID KENNETH (MS)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:KENNETH
Last Name:WATKINS
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 WYNTRE BROOKE DRIVE
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17403-4535
Mailing Address - Country:US
Mailing Address - Phone:717-741-0661
Mailing Address - Fax:717-741-0361
Practice Address - Street 1:6 WYNTRE BROOKE DRIVE
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-4535
Practice Address - Country:US
Practice Address - Phone:717-741-0661
Practice Address - Fax:717-741-0361
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS003047L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist