Provider Demographics
NPI:1265112742
Name:WATKINS, HANNAH (LAC)
Entity type:Individual
Prefix:
First Name:HANNAH
Middle Name:
Last Name:WATKINS
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16274 CYPRESS LN
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72756-6376
Mailing Address - Country:US
Mailing Address - Phone:479-659-9947
Mailing Address - Fax:
Practice Address - Street 1:111 SE 22ND ST STE 11
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-5180
Practice Address - Country:US
Practice Address - Phone:479-268-3280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-20
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA2210025101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health