Provider Demographics
NPI:1225550403
Name:WASHINGTON, WESLEY KEITH (LPC)
Entity Type:Individual
Prefix:
First Name:WESLEY
Middle Name:KEITH
Last Name:WASHINGTON
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7150 KALAMAZOO AVE SE
Mailing Address - Street 2:SUITE C
Mailing Address - City:CALEDONIA
Mailing Address - State:MI
Mailing Address - Zip Code:49316-1201
Mailing Address - Country:US
Mailing Address - Phone:616-219-0159
Mailing Address - Fax:
Practice Address - Street 1:7150 KALAMAZOO AVE SE
Practice Address - Street 2:SUITE C
Practice Address - City:CALEDONIA
Practice Address - State:MI
Practice Address - Zip Code:49316
Practice Address - Country:US
Practice Address - Phone:616-219-0159
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401016188101Y00000X
MI6401018485101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor