Provider Demographics
NPI:1972356293
Name:WATSON, NOAH F (LCMHCA, LCASA)
Entity Type:Individual
Prefix:
First Name:NOAH
Middle Name:F
Last Name:WATSON
Suffix:
Gender:M
Credentials:LCMHCA, LCASA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3806 PEACHTREE AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-6752
Mailing Address - Country:US
Mailing Address - Phone:910-251-7789
Mailing Address - Fax:
Practice Address - Street 1:3806 PEACHTREE AVE STE 210
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-6752
Practice Address - Country:US
Practice Address - Phone:910-251-7789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-08
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA19709101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional