Provider Demographics
NPI:1255987061
Name:WATSON, DONTAE ANTHONY
Entity type:Individual
Prefix:
First Name:DONTAE
Middle Name:ANTHONY
Last Name:WATSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4125 LEAD AVE SE APT 104
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87108-2655
Mailing Address - Country:US
Mailing Address - Phone:202-577-1028
Mailing Address - Fax:
Practice Address - Street 1:4125 LEAD AVE SE APT 104
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108-2655
Practice Address - Country:US
Practice Address - Phone:202-577-1028
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-16
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst