Provider Demographics
NPI:1720401813
Name:TWINER-WATKINS, ANITA (LCSW)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:
Last Name:TWINER-WATKINS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:719 24TH ST
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39501-3408
Mailing Address - Country:US
Mailing Address - Phone:601-255-7937
Mailing Address - Fax:
Practice Address - Street 1:110 HAWTHORNE DR
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:MS
Practice Address - Zip Code:39560-8201
Practice Address - Country:US
Practice Address - Phone:601-255-7937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-27
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSC80401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical