Individual
JUDITH WATITI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
16040 HAYES LN, WOODBRIDGE, VA 22191-4537
(254) 702-1463
Mailing address
16040 HAYES LN, WOODBRIDGE, VA 22191-4537
(254) 702-1463
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
11172
TX
101YP2500X
Professional Counselor
Primary
0701006784
VA
101YP2500X
Professional Counselor
49234
TX
Other
Enumeration date
04/30/2017
Last updated
04/30/2017
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