Provider Demographics
NPI:1366167421
Name:WATKINS MEDLIN, CINDY SUSAN (LCSWA)
Entity type:Individual
Prefix:MS
First Name:CINDY
Middle Name:SUSAN
Last Name:WATKINS MEDLIN
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1917 TRENT BLVD
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28560-4537
Mailing Address - Country:US
Mailing Address - Phone:252-631-5337
Mailing Address - Fax:252-631-5342
Practice Address - Street 1:1917 TRENT BLVD
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28560-4537
Practice Address - Country:US
Practice Address - Phone:252-631-5337
Practice Address - Fax:252-631-5342
Is Sole Proprietor?:No
Enumeration Date:2022-10-11
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP148571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical