Provider Demographics
NPI:1861101800
Name:WATKINS, YOLONDA NICOLE (LMT)
Entity type:Individual
Prefix:MRS
First Name:YOLONDA
Middle Name:NICOLE
Last Name:WATKINS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5638 FLANDERS AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-3416
Mailing Address - Country:US
Mailing Address - Phone:240-646-6891
Mailing Address - Fax:
Practice Address - Street 1:5638 FLANDERS AVE
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-3416
Practice Address - Country:US
Practice Address - Phone:240-646-6891
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-17
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC12987225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist