Individual
CHARLOTTE LYNN WATTERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
505 S PACIFIC AVE # 105, SAN PEDRO, CA 90731-2656
(310) 519-8723
Mailing address
PO BOX 729, REDONDO BEACH, CA 90277-0729
(310) 880-3504
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
R1364260919
CA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
08/24/2016
Last updated
10/20/2023
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