Provider Demographics
NPI:1457064495
Name:WATSON, TWANNA MONIQUE (LPC)
Entity Type:Individual
Prefix:
First Name:TWANNA
Middle Name:MONIQUE
Last Name:WATSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 W GRAND AVE APT 214
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-2580
Mailing Address - Country:US
Mailing Address - Phone:832-881-0258
Mailing Address - Fax:
Practice Address - Street 1:730 W GRAND AVE UNIT 3103
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-2581
Practice Address - Country:US
Practice Address - Phone:832-881-0258
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-04
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX77042101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional