Provider Demographics
NPI:1114698800
Name:WASHINGTON, CHARLONDA
Entity Type:Individual
Prefix:
First Name:CHARLONDA
Middle Name:
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 1:135 HILLTOP DR
Mailing Address - Street 2:
Mailing Address - City:FOUR OAKS
Mailing Address - State:NC
Mailing Address - Zip Code:27524-9686
Mailing Address - Country:US
Mailing Address - Phone:919-836-3433
Mailing Address - Fax:
Practice Address - Street 1:135 HILLTOP DR
Practice Address - Street 2:
Practice Address - City:FOUR OAKS
Practice Address - State:NC
Practice Address - Zip Code:27524-9686
Practice Address - Country:US
Practice Address - Phone:919-836-3433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-23
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician