Provider Demographics
NPI:1306891437
Name:WATKINS, MARY EDITH (MA, LPC, CCMHC, NCC)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:EDITH
Last Name:WATKINS
Suffix:
Gender:F
Credentials:MA, LPC, CCMHC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:804 S GARNETT ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NC
Mailing Address - Zip Code:27536-4571
Mailing Address - Country:US
Mailing Address - Phone:252-438-2994
Mailing Address - Fax:252-438-6594
Practice Address - Street 1:804 S GARNETT ST
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NC
Practice Address - Zip Code:27536-4571
Practice Address - Country:US
Practice Address - Phone:252-438-2994
Practice Address - Fax:252-438-6594
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-24
Last Update Date:2019-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLPC #374101YM0800X
NCLPC #374101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC032581OtherTRIGON BC/BS
NC16802OtherPARTNERS
NC17185OtherUBH & UHC EAP, MC AND IN
NC32581OtherANTHEM INS
NC4274855OtherAETNA INS
NC057499OtherHORIZON EAP AND INS
NC85940OtherBC/BS INS
NC17185OtherOPTUM
NC20405OtherMAGELLAN INS AND MAN CAR
NC053551000OtherMAGELLAN EAP
NC46571OtherFEI EAP AND INS