Provider Demographics
NPI:1194041335
Name:WASHINGTON, NAKIA M (MED)
Entity Type:Individual
Prefix:MISS
First Name:NAKIA
Middle Name:M
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 WHEELER VILLAGE RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06489-3753
Mailing Address - Country:US
Mailing Address - Phone:860-461-5126
Mailing Address - Fax:
Practice Address - Street 1:105 SPRING ST
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105-2112
Practice Address - Country:US
Practice Address - Phone:860-522-9363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-13
Last Update Date:2010-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children