1447282348 NPI number — SUSAN D WATKINS MSW, CSW

Table of content: SUSAN D WATKINS MSW, CSW (NPI 1447282348)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447282348 NPI number — SUSAN D WATKINS MSW, CSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WATKINS
Provider First Name:
SUSAN
Provider Middle Name:
D
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSW, CSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1447282348
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
509 ALDER ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BURLINGTON
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27217-3101
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-286-0411
Provider Business Mailing Address Fax Number:
919-416-5834

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
508 FULTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DURHAM
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27705-3875
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-286-0411
Provider Business Practice Location Address Fax Number:
919-416-5834
Provider Enumeration Date:
07/07/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  CP00450850 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)