Individual
ADDIE WATSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1310 ELWELL AVE, GREENSBORO, NC 27405-6118
(336) 275-1461
Mailing address
P.O. BOX 20084, GREENSBORO, NC 27420-0084
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
MHL041048
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3406414
—
NC
Enumeration date
03/23/2007
Last updated
03/04/2024
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