Provider Demographics
NPI:1306529367
Name:WATSON, JENNIFER HARRIS (PHD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:HARRIS
Last Name:WATSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 COLONY DR
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:SC
Mailing Address - Zip Code:29020-9337
Mailing Address - Country:US
Mailing Address - Phone:803-428-7550
Mailing Address - Fax:
Practice Address - Street 1:29 COLONY DR
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:SC
Practice Address - Zip Code:29020-9337
Practice Address - Country:US
Practice Address - Phone:803-428-7550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-08
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-18-33508103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst