Provider Demographics
NPI:1295915882
Name:WATTS, MARY MAGDALENE (MS)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:MAGDALENE
Last Name:WATTS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MISS
Other - First Name:MARY
Other - Middle Name:MAGDALENE
Other - Last Name:FREEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:2694 S PARK AVE
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36301-4904
Mailing Address - Country:US
Mailing Address - Phone:334-712-2720
Mailing Address - Fax:334-712-2727
Practice Address - Street 1:1539 SWEETIE SMITH RD
Practice Address - Street 2:
Practice Address - City:ASHFORD
Practice Address - State:AL
Practice Address - Zip Code:36312-7422
Practice Address - Country:US
Practice Address - Phone:334-690-8030
Practice Address - Fax:334-691-8029
Is Sole Proprietor?:No
Enumeration Date:2007-11-12
Last Update Date:2007-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health