Provider Demographics
NPI:1356554307
Name:WATTERS, TRICIA DENISE (LCSW)
Entity type:Individual
Prefix:
First Name:TRICIA
Middle Name:DENISE
Last Name:WATTERS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9379 IRONSTONE WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95829-6108
Mailing Address - Country:US
Mailing Address - Phone:196-875-6232
Mailing Address - Fax:916-875-5095
Practice Address - Street 1:7171 BOWLING DR
Practice Address - Street 2:SUITE 400
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-2034
Practice Address - Country:US
Practice Address - Phone:916-875-6232
Practice Address - Fax:916-875-5095
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2007-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS217631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical