Provider Demographics
NPI:1174995153
Name:WATSON, SHERRY LORRAINE (CDP)
Entity type:Individual
Prefix:MS
First Name:SHERRY
Middle Name:LORRAINE
Last Name:WATSON
Suffix:
Gender:F
Credentials:CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1550 IRVING ST SW STE 301
Mailing Address - Street 2:
Mailing Address - City:TUMWATER
Mailing Address - State:WA
Mailing Address - Zip Code:98512-6362
Mailing Address - Country:US
Mailing Address - Phone:360-870-9252
Mailing Address - Fax:
Practice Address - Street 1:1550 IRVING ST SW STE 301
Practice Address - Street 2:
Practice Address - City:TUMWATER
Practice Address - State:WA
Practice Address - Zip Code:98512-6362
Practice Address - Country:US
Practice Address - Phone:360-870-9252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-29
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP 00002667101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2077844Medicaid