Provider Demographics
NPI:1003643883
Name:WATKINS, FORMEKA (SWC)
Entity type:Individual
Prefix:
First Name:FORMEKA
Middle Name:
Last Name:WATKINS
Suffix:
Gender:F
Credentials:SWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18624 E MAINSTREET APT 5-201
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-5056
Mailing Address - Country:US
Mailing Address - Phone:470-273-9375
Mailing Address - Fax:
Practice Address - Street 1:18624 E MAINSTREET APT 5-201
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134-5056
Practice Address - Country:US
Practice Address - Phone:470-273-9375
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-17
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO00000019891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty