Provider Demographics
NPI:1932256369
Name:WATSON, INA J (LCSW)
Entity Type:Individual
Prefix:
First Name:INA
Middle Name:J
Last Name:WATSON
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 1:5249 DUKE ST STE 200
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-2907
Mailing Address - Country:US
Mailing Address - Phone:703-823-3972
Mailing Address - Fax:
Practice Address - Street 1:5249 DUKE ST STE 200
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-2907
Practice Address - Country:US
Practice Address - Phone:703-823-3972
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040021571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1745OtherCARE FIRST BCBS