Provider Demographics
NPI:1083946354
Name:WASHINGTON, MINNIE ETHEL (CIT MMPH)
Entity Type:Individual
Prefix:
First Name:MINNIE
Middle Name:ETHEL
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:CIT MMPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 2578
Mailing Address - Street 2:
Mailing Address - City:BATVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72501
Mailing Address - Country:US
Mailing Address - Phone:870-793-8900
Mailing Address - Fax:870-633-2624
Practice Address - Street 1:900 W POPLAR ST STE 100
Practice Address - Street 2:
Practice Address - City:MC CRORY
Practice Address - State:AR
Practice Address - Zip Code:72101-8266
Practice Address - Country:US
Practice Address - Phone:866-533-1757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-11
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health