Provider Demographics
NPI:1063700060
Name:WATSON, RHONDA YVETTE (LCSW)
Entity type:Individual
Prefix:MS
First Name:RHONDA
Middle Name:YVETTE
Last Name:WATSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4175 DEFOORS FARM DR
Mailing Address - Street 2:
Mailing Address - City:POWDER SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30127-4078
Mailing Address - Country:US
Mailing Address - Phone:410-499-0743
Mailing Address - Fax:
Practice Address - Street 1:4175 DEFOORS FARM DR
Practice Address - Street 2:
Practice Address - City:POWDER SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30127-4078
Practice Address - Country:US
Practice Address - Phone:410-499-0743
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-12
Last Update Date:2011-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0035961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical