Provider Demographics
NPI:1952039133
Name:WATKINS, TAYLOR (PEER SUPPORT SPECIAL)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:WATKINS
Suffix:
Gender:M
Credentials:PEER SUPPORT SPECIAL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:248 SOUTH PELHAM
Mailing Address - Street 2:248 SOUTH PELHAM
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-1572
Mailing Address - Country:US
Mailing Address - Phone:937-260-2183
Mailing Address - Fax:937-853-0096
Practice Address - Street 1:1320 WOODMAN DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45432-3497
Practice Address - Country:US
Practice Address - Phone:100-000-0000
Practice Address - Fax:937-853-0096
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-15
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.187704101YA0400X
OH0003140175T00000X
175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No175T00000XOther Service ProvidersPeer Specialist