Provider Demographics
NPI:1124483227
Name:ANDREA WATKINS LCSW
Entity type:Organization
Organization Name:ANDREA WATKINS LCSW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:J
Authorized Official - Last Name:WATKINS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:224-330-7438
Mailing Address - Street 1:175 OLDE HALF DAY RD
Mailing Address - Street 2:SUITE 100-15
Mailing Address - City:LINCOLNSHIRE
Mailing Address - State:IL
Mailing Address - Zip Code:60069-3061
Mailing Address - Country:US
Mailing Address - Phone:224-330-7438
Mailing Address - Fax:
Practice Address - Street 1:175 OLDE HALF DAY RD
Practice Address - Street 2:SUITE 100-15
Practice Address - City:LINCOLNSHIRE
Practice Address - State:IL
Practice Address - Zip Code:60069-3061
Practice Address - Country:US
Practice Address - Phone:224-330-7438
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-16
Last Update Date:2015-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490146681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty