Provider Demographics
NPI:1609482751
Name:WATSON, ALYSSA JACKLYN (INTERN)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:JACKLYN
Last Name:WATSON
Suffix:
Gender:F
Credentials:INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 HALONA ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-2796
Mailing Address - Country:US
Mailing Address - Phone:808-843-5312
Mailing Address - Fax:
Practice Address - Street 1:1300 HALONA ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-2796
Practice Address - Country:US
Practice Address - Phone:808-726-9844
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-23
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health