Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | PC011422 | PA |
NPI | 1003456492 |
---|---|
Provider Name | Samuel Watkins |
First Address | Harrisburg, PA 17110-1930 |
Second Address | Harrisburg, PA 17110-1930 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/01/2020 |
Last Update Date | 14/01/2020 |