Provider Demographics
NPI:1053943878
Name:WATKINS, NAYLECIA MONIQUE
Entity type:Individual
Prefix:MRS
First Name:NAYLECIA
Middle Name:MONIQUE
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 1:5701 MABLETON PKWY SW STE 300
Mailing Address - Street 2:
Mailing Address - City:MABLETON
Mailing Address - State:GA
Mailing Address - Zip Code:30126-3364
Mailing Address - Country:US
Mailing Address - Phone:470-552-4780
Mailing Address - Fax:
Practice Address - Street 1:5701 MABLETON PKWY SW STE 300
Practice Address - Street 2:
Practice Address - City:MABLETON
Practice Address - State:GA
Practice Address - Zip Code:30126-3364
Practice Address - Country:US
Practice Address - Phone:470-552-4780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-10
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA175T00000X, 101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No175T00000XOther Service ProvidersPeer Specialist