Provider Demographics
NPI:1710609375
Name:WATTS, LORI EILEEN (MA)
Entity Type:Individual
Prefix:MS
First Name:LORI
Middle Name:EILEEN
Last Name:WATTS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MRS
Other - First Name:LORI
Other - Middle Name:EILEEN
Other - Last Name:WATTS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA
Mailing Address - Street 1:7207 YOUNG ST
Mailing Address - Street 2:
Mailing Address - City:MACHIPONGO
Mailing Address - State:VA
Mailing Address - Zip Code:23405-1725
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7207 YOUNG ST
Practice Address - Street 2:
Practice Address - City:MACHIPONGO
Practice Address - State:VA
Practice Address - Zip Code:23405-1725
Practice Address - Country:US
Practice Address - Phone:757-678-5151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-12
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TS0200X
VA0813000876103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool