Provider Demographics
NPI:1750461497
Name:WATTS, DOROTHY D (LCSW)
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:D
Last Name:WATTS
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 1:175 COUNTRY CLUB DRIVE
Mailing Address - Street 2:SUITE 200E
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281
Mailing Address - Country:US
Mailing Address - Phone:770-389-1925
Mailing Address - Fax:770-389-3077
Practice Address - Street 1:175 COUNTRY CLUB DRIVE
Practice Address - Street 2:SUITE 200E
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281
Practice Address - Country:US
Practice Address - Phone:770-389-1925
Practice Address - Fax:770-389-3077
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW 002841106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA80BBFNZMedicare ID - Type Unspecified
P39937Medicare UPIN