Provider Demographics
NPI:1578445102
Name:WATKINS, CODY (LGPC)
Entity type:Individual
Prefix:
First Name:CODY
Middle Name:
Last Name:WATKINS
Suffix:
Gender:M
Credentials:LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12502 WILLOWBROOK RD STE 380
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-6592
Mailing Address - Country:US
Mailing Address - Phone:240-964-8585
Mailing Address - Fax:240-979-8586
Practice Address - Street 1:12502 WILLOWBROOK RD STE 380
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-6592
Practice Address - Country:US
Practice Address - Phone:240-964-8585
Practice Address - Fax:240-979-8586
Is Sole Proprietor?:No
Enumeration Date:2025-07-24
Last Update Date:2025-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP15121101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health