Provider Demographics
NPI:1831063676
Name:WATKINS, DERRICK ANTONIO (BS)
Entity type:Individual
Prefix:MR
First Name:DERRICK
Middle Name:ANTONIO
Last Name:WATKINS
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:606 ATHERTON WAY
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29730-8093
Mailing Address - Country:US
Mailing Address - Phone:803-412-5738
Mailing Address - Fax:
Practice Address - Street 1:606 ATHERTON WAY
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29730-8093
Practice Address - Country:US
Practice Address - Phone:803-412-5738
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-03
Last Update Date:2025-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty