Provider Demographics
NPI:1861097354
Name:WATSON, WILLIAM CHRISTOPHER (MA, LADC)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:CHRISTOPHER
Last Name:WATSON
Suffix:
Gender:M
Credentials:MA, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2118 BLAISDELL AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55404-2415
Mailing Address - Country:US
Mailing Address - Phone:651-380-6053
Mailing Address - Fax:
Practice Address - Street 1:124 TYLER RD S
Practice Address - Street 2:
Practice Address - City:RED WING
Practice Address - State:MN
Practice Address - Zip Code:55066-1733
Practice Address - Country:US
Practice Address - Phone:651-977-5001
Practice Address - Fax:651-977-5002
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-02
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN305436101YA0400X
MN4324101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)