Provider Demographics
NPI:1811402001
Name:WATSON, BRITTANY DEJRUNE'
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:DEJRUNE'
Last Name:WATSON
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 1:301 HUNTER DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT AIRY
Mailing Address - State:NC
Mailing Address - Zip Code:27030-3603
Mailing Address - Country:US
Mailing Address - Phone:336-783-7876
Mailing Address - Fax:
Practice Address - Street 1:301 HUNTER DR
Practice Address - Street 2:
Practice Address - City:MOUNT AIRY
Practice Address - State:NC
Practice Address - Zip Code:27030-3603
Practice Address - Country:US
Practice Address - Phone:336-783-7876
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-10
Last Update Date:2018-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency