Individual
KIMBERLY JEAN WATTS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW,MSW,CADC
Contact information
Practice address
3004 GRAND AVE, WAUKEGAN, IL 60085-2321
(847) 377-8120
Mailing address
10 HAWTHORNE LN, FOX LAKE, IL 60020-1809
(847) 775-9552
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
1041C0700X
Clinical Social Worker
149019701
IL
Other
Enumeration date
08/11/2016
Last updated
10/06/2017
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