Provider Demographics
NPI:1205473360
Name:WATSON, KEONNA M (DSOCSCI, MS, BCHHP)
Entity type:Individual
Prefix:DR
First Name:KEONNA
Middle Name:M
Last Name:WATSON
Suffix:
Gender:F
Credentials:DSOCSCI, MS, BCHHP
Other - Prefix:DR
Other - First Name:KEONNA
Other - Middle Name:M
Other - Last Name:FREEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DSOCSCI, MS, BCHHP
Mailing Address - Street 1:411 ROLLING GREEN AVE
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:DE
Mailing Address - Zip Code:19720-4791
Mailing Address - Country:US
Mailing Address - Phone:302-277-7161
Mailing Address - Fax:302-566-2853
Practice Address - Street 1:3125 NEW CASTLE AVE STE 3
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:DE
Practice Address - Zip Code:19720-2174
Practice Address - Country:US
Practice Address - Phone:302-277-7161
Practice Address - Fax:302-566-2853
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-06
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171400000XOther Service ProvidersHealth & Wellness Coach
No174H00000XOther Service ProvidersHealth Educator
No175F00000XOther Service ProvidersNaturopath