Provider Demographics
NPI:1720249857
Name:WATSON, TAMICA MARIE
Entity type:Individual
Prefix:MRS
First Name:TAMICA
Middle Name:MARIE
Last Name:WATSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TAMICA
Other - Middle Name:MARIE
Other - Last Name:BURNETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:126 SANDALWOOD CT
Mailing Address - Street 2:
Mailing Address - City:WALKERSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21793-8150
Mailing Address - Country:US
Mailing Address - Phone:240-291-2171
Mailing Address - Fax:
Practice Address - Street 1:126 SANDALWOOD CT
Practice Address - Street 2:
Practice Address - City:WALKERSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21793-8150
Practice Address - Country:US
Practice Address - Phone:240-291-2171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-20
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health