Provider Demographics
NPI:1164826194
Name:WASHINGTON, DEMETRIUS DEWYANE
Entity Type:Individual
Prefix:MR
First Name:DEMETRIUS
Middle Name:DEWYANE
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 1:324 N 13TH AVE
Mailing Address - Street 2:1901 BAKER STREET
Mailing Address - City:ARCADIA
Mailing Address - State:FL
Mailing Address - Zip Code:34266-8922
Mailing Address - Country:US
Mailing Address - Phone:863-244-2836
Mailing Address - Fax:
Practice Address - Street 1:324 N 13TH AVE
Practice Address - Street 2:1901 BAKER STREET
Practice Address - City:ARCADIA
Practice Address - State:FL
Practice Address - Zip Code:34266-8922
Practice Address - Country:US
Practice Address - Phone:863-244-2836
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-20
Last Update Date:2014-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL101YM0800X101Y00000X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor