Provider Demographics
NPI:1154854669
Name:WASHINGTON, ALEXIS CECILIA (MED)
Entity Type:Individual
Prefix:MRS
First Name:ALEXIS
Middle Name:CECILIA
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:MED
Other - Prefix:MS
Other - First Name:ALEXIS
Other - Middle Name:CECILIA
Other - Last Name:WASHINGTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2525 ONEAL LN APT 702
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-3417
Mailing Address - Country:US
Mailing Address - Phone:337-936-2371
Mailing Address - Fax:
Practice Address - Street 1:1724 N BURNSIDE AVE
Practice Address - Street 2:
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737-2157
Practice Address - Country:US
Practice Address - Phone:225-644-8565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-11
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool