Provider Demographics
NPI:1063190643
Name:WATKINS, ANGI NICOLE
Entity type:Individual
Prefix:MS
First Name:ANGI
Middle Name:NICOLE
Last Name:WATKINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 HEARTH MANOR DR
Mailing Address - Street 2:
Mailing Address - City:ARCOLA
Mailing Address - State:TX
Mailing Address - Zip Code:77583-4895
Mailing Address - Country:US
Mailing Address - Phone:832-493-0316
Mailing Address - Fax:
Practice Address - Street 1:10811 MONROE RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77075-4899
Practice Address - Country:US
Practice Address - Phone:713-740-5460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-05
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YS0200X
TX90892101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool