Provider Demographics
NPI:1386996643
Name:WATSON, JUNETTA (LPC)
Entity type:Individual
Prefix:MRS
First Name:JUNETTA
Middle Name:
Last Name:WATSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3120 N OAK ST
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-1003
Mailing Address - Country:US
Mailing Address - Phone:229-671-6100
Mailing Address - Fax:229-671-6774
Practice Address - Street 1:334 TIFTON ELDORADO RD
Practice Address - Street 2:
Practice Address - City:TIFTON
Practice Address - State:GA
Practice Address - Zip Code:31794-9497
Practice Address - Country:US
Practice Address - Phone:229-391-2300
Practice Address - Fax:229-671-6774
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-11
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA006968101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA006968OtherLICENSE