Provider Demographics
NPI:1861620221
Name:WATKINS, RODERICK Y (LPC)
Entity type:Individual
Prefix:MR
First Name:RODERICK
Middle Name:Y
Last Name:WATKINS
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1365 MEMORIAL DR SE
Mailing Address - Street 2:UNIT 6
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30317-1700
Mailing Address - Country:US
Mailing Address - Phone:678-632-1022
Mailing Address - Fax:
Practice Address - Street 1:3915 CASCADE RD SW STE 105
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-8519
Practice Address - Country:US
Practice Address - Phone:678-632-1022
Practice Address - Fax:630-839-7240
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-24
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health