Provider Demographics
NPI:1841244506
Name:WATFORD, DOVIE PAULINE (MS)
Entity Type:Individual
Prefix:MRS
First Name:DOVIE
Middle Name:PAULINE
Last Name:WATFORD
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19216 N 61ST AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-7683
Mailing Address - Country:US
Mailing Address - Phone:623-825-4650
Mailing Address - Fax:
Practice Address - Street 1:11225 N 28TH DR
Practice Address - Street 2:SUITE D213
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029-5606
Practice Address - Country:US
Practice Address - Phone:602-993-4323
Practice Address - Fax:602-993-0867
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZCC0486101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health