Provider Demographics
NPI:1891316667
Name:WATKINS, DEMETRIC (LMHC)
Entity Type:Individual
Prefix:
First Name:DEMETRIC
Middle Name:
Last Name:WATKINS
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7037 SPOTTED DEER PL
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33578-8977
Mailing Address - Country:US
Mailing Address - Phone:813-501-3124
Mailing Address - Fax:813-492-2195
Practice Address - Street 1:7901 4TH ST N STE 300
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33702-4399
Practice Address - Country:US
Practice Address - Phone:813-501-3124
Practice Address - Fax:813-492-2195
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-02
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH21916101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLIMH19450OtherMENTAL HEALTH COUNSELOR