Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor | GA |
NPI | 1053943878 |
---|---|
Provider Name | Mrs. Naylecia Monique Watkins |
First Address | Mableton, GA 30126-3364 |
Second Address | Mableton, GA 30126-3364 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/02/2020 |
Last Update Date | 10/02/2020 |