Provider Demographics
NPI:1962008516
Name:WATSON, TERRINAE (MDIV)
Entity Type:Individual
Prefix:
First Name:TERRINAE
Middle Name:
Last Name:WATSON
Suffix:
Gender:F
Credentials:MDIV
Other - Prefix:
Other - First Name:T. LUNA
Other - Middle Name:
Other - Last Name:IMHOTEP
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MDIV
Mailing Address - Street 1:26 DANNER CIR
Mailing Address - Street 2:
Mailing Address - City:SPANISH FORT
Mailing Address - State:AL
Mailing Address - Zip Code:36527-3064
Mailing Address - Country:US
Mailing Address - Phone:251-620-9196
Mailing Address - Fax:
Practice Address - Street 1:26 DANNER CIR
Practice Address - Street 2:
Practice Address - City:SPANISH FORT
Practice Address - State:AL
Practice Address - Zip Code:36527-3064
Practice Address - Country:US
Practice Address - Phone:251-620-9196
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-09
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopath
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Multi-Specialty
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, EducationGroup - Multi-Specialty
No172V00000XOther Service ProvidersCommunity Health Worker
No173C00000XOther Service ProvidersReflexologist
No174200000XOther Service ProvidersMeals
No174H00000XOther Service ProvidersHealth Educator
No175T00000XOther Service ProvidersPeer Specialist
No251S00000XAgenciesCommunity/Behavioral Health
No261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthing
No374J00000XNursing Service Related ProvidersDoula
No374K00000XNursing Service Related ProvidersReligious Nonmedical Practitioner