Provider Demographics
NPI:1700028222
Name:WATKINS, JAMIE CLARICE (BA)
Entity Type:Individual
Prefix:MS
First Name:JAMIE
Middle Name:CLARICE
Last Name:WATKINS
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1507 WINONA BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-5003
Mailing Address - Country:US
Mailing Address - Phone:323-644-3500
Mailing Address - Fax:323-644-3505
Practice Address - Street 1:6636 SELMA AVE
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90028-7115
Practice Address - Country:US
Practice Address - Phone:323-460-6220
Practice Address - Fax:323-461-3282
Is Sole Proprietor?:No
Enumeration Date:2009-03-30
Last Update Date:2009-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health