Active NPI
Andrea Watson, PCCCSS
- Counselor
- Purvis, MS
National Provider Identifier
1790546141
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- License
- 4139
- Practice address
- 805 Highway 589
Purvis, MS 39475-4194 - Phone
- (601) 794-6543
- Fax
- (601) 794-2455
- NPI assigned
- Jan 22, 2024
- Last updated
- Jan 22, 2024
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | 4139 | MS | Primary |
Addresses
Primary practice location
805 Highway 589
Purvis, MS 39475-4194
Mailing address
PO Box 18679
Hattiesburg, MS 39404-8679
Phone (601) 705-1901
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4139 | MS | MD | Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1705881600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1705881600000",
"number": "1790546141",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 18679",
"city": "HATTIESBURG",
"state": "MS",
"postal_code": "394048679",
"telephone_number": "601-705-1901"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "805 HIGHWAY 589",
"city": "PURVIS",
"state": "MS",
"postal_code": "394754194",
"telephone_number": "601-794-6543",
"fax_number": "601-794-2455"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WATSON",
"first_name": "ANDREA",
"credential": "PCCCSS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-01-22",
"last_updated": "2024-01-22",
"certification_date": "2024-01-22",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "MS",
"license": "4139",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Purvis, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.