Basic Information
| Provider Information | |||||||||
| NPI: | 1770030918 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WATKINS | ||||||||
| FirstName: | CAROLINE | ||||||||
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| Credential: | MSW, LCSWA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2327 SELWYN AVE | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282072713 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7046814633 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5108 REAGAN DR | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282063103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7043328787 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/06/2016 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | N | Behavioral Health & Social Service Providers | Social Worker | 1041C0700X | P011999 | NC | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.