Provider Demographics
NPI:1093259897
Name:WASHINGTON, ANITA LANISE
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:LANISE
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2409 MERCED STREET
Mailing Address - Street 2:#106
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93721
Mailing Address - Country:US
Mailing Address - Phone:559-981-2975
Mailing Address - Fax:559-981-2965
Practice Address - Street 1:2409 MERCED ST
Practice Address - Street 2:#106
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93721-1829
Practice Address - Country:US
Practice Address - Phone:559-981-2975
Practice Address - Fax:559-981-2965
Is Sole Proprietor?:No
Enumeration Date:2016-12-13
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor