Provider Demographics
NPI:1164094082
Name:WASHINGTON, LADARION
Entity Type:Individual
Prefix:
First Name:LADARION
Middle Name:
Last Name:WASHINGTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14391 CASS COUNTY RD
Mailing Address - Street 2:
Mailing Address - City:VIVIAN
Mailing Address - State:LA
Mailing Address - Zip Code:71082-9137
Mailing Address - Country:US
Mailing Address - Phone:318-218-2288
Mailing Address - Fax:
Practice Address - Street 1:14391 CASS COUNTY RD
Practice Address - Street 2:
Practice Address - City:VIVIAN
Practice Address - State:LA
Practice Address - Zip Code:71082-9137
Practice Address - Country:US
Practice Address - Phone:318-218-2288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-12
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health