Provider Demographics
NPI:1689879140
Name:WATSON, WILLIE
Entity Type:Individual
Prefix:
First Name:WILLIE
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 1:5 CORDREY RD
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2312
Mailing Address - Country:US
Mailing Address - Phone:302-368-4431
Mailing Address - Fax:
Practice Address - Street 1:25 S OLD BALTIMORE PIKE
Practice Address - Street 2:LAFAYETTE BLDG. II, SUITE 400
Practice Address - City:CHRISTIANA
Practice Address - State:DE
Practice Address - Zip Code:19702-1540
Practice Address - Country:US
Practice Address - Phone:302-368-7453
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-15
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEPC-0000409101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional