Provider Demographics
NPI:1710373576
Name:WATKINS, ASHLEY
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:WATKINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12105 WESTLOCK PL
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20708-2422
Mailing Address - Country:US
Mailing Address - Phone:240-988-2417
Mailing Address - Fax:301-856-3051
Practice Address - Street 1:9135 PISCATAWAY RD
Practice Address - Street 2:SUITE 245
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-2549
Practice Address - Country:US
Practice Address - Phone:240-348-6104
Practice Address - Fax:301-856-3051
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-08
Last Update Date:2015-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health