Provider Demographics
NPI:1912735333
Name:WATTS, JOHNNY F (SUDP, ADMINISTRATOR)
Entity type:Individual
Prefix:MR
First Name:JOHNNY
Middle Name:F
Last Name:WATTS
Suffix:
Gender:M
Credentials:SUDP, ADMINISTRATOR
Other - Prefix:MR
Other - First Name:JOHNNY
Other - Middle Name:F
Other - Last Name:WATTS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:SUDP
Mailing Address - Street 1:806 S VINE ST
Mailing Address - Street 2:
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98362-7982
Mailing Address - Country:US
Mailing Address - Phone:360-452-2443
Mailing Address - Fax:360-452-2738
Practice Address - Street 1:806 S VINE ST
Practice Address - Street 2:
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98362-7982
Practice Address - Country:US
Practice Address - Phone:360-452-2443
Practice Address - Fax:360-452-2738
Is Sole Proprietor?:No
Enumeration Date:2024-07-25
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP60277883101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)