Provider Demographics
NPI:1871279893
Name:WATKINS, IMANI
Entity type:Individual
Prefix:
First Name:IMANI
Middle Name:
Last Name:WATKINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2316 RAMBLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:DISTRICT HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20747-2350
Mailing Address - Country:US
Mailing Address - Phone:240-725-8110
Mailing Address - Fax:
Practice Address - Street 1:8405 RICHMOND HWY STE E
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22309-2425
Practice Address - Country:US
Practice Address - Phone:703-896-0760
Practice Address - Fax:571-503-9992
Is Sole Proprietor?:No
Enumeration Date:2023-06-26
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician