Provider Demographics
NPI:1447669155
Name:WATSON, AUDREY (PHD)
Entity type:Individual
Prefix:DR
First Name:AUDREY
Middle Name:
Last Name:WATSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 COMMERCE PLAZA CIR
Mailing Address - Street 2:SUITE A
Mailing Address - City:PEMBROKE
Mailing Address - State:NC
Mailing Address - Zip Code:28372-7386
Mailing Address - Country:US
Mailing Address - Phone:910-521-2900
Mailing Address - Fax:910-775-9165
Practice Address - Street 1:108 W FIRE TOWER RD
Practice Address - Street 2:STE E
Practice Address - City:WINTERVILLE
Practice Address - State:NC
Practice Address - Zip Code:28590-8371
Practice Address - Country:US
Practice Address - Phone:252-752-5555
Practice Address - Fax:252-752-5455
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-06
Last Update Date:2016-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJC7LC00203000101YA0400X
CT44001010101YA0400X
NCLCAS-23050101YA0400X
NCCSAC-20068101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor