Provider Demographics
NPI:1649322470
Name:WATKINS, MARTHA E (MS, LPC)
Entity type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:E
Last Name:WATKINS
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 PAGE PL
Mailing Address - Street 2:
Mailing Address - City:EMERALD ISLE
Mailing Address - State:NC
Mailing Address - Zip Code:28594-2324
Mailing Address - Country:US
Mailing Address - Phone:252-269-9262
Mailing Address - Fax:
Practice Address - Street 1:115 PAGE PL
Practice Address - Street 2:
Practice Address - City:EMERALD ISLE
Practice Address - State:NC
Practice Address - Zip Code:28594-2324
Practice Address - Country:US
Practice Address - Phone:252-269-9262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5459101Y00000X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional