Provider Demographics
NPI:1235574633
Name:WASHINGTON, EVA (LCMHC LCAS)
Entity Type:Individual
Prefix:
First Name:EVA
Middle Name:
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:LCMHC LCAS
Other - Prefix:
Other - First Name:EVA
Other - Middle Name:
Other - Last Name:WASHINGTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:108 CARVER DRIVE
Mailing Address - Street 2:
Mailing Address - City:SNOW HILL
Mailing Address - State:NC
Mailing Address - Zip Code:28580-1302
Mailing Address - Country:US
Mailing Address - Phone:336-312-3818
Mailing Address - Fax:336-450-4358
Practice Address - Street 1:108 N. FRANKLIN STREET
Practice Address - Street 2:OFFICE A
Practice Address - City:MADISON
Practice Address - State:NC
Practice Address - Zip Code:27025-1673
Practice Address - Country:US
Practice Address - Phone:336-312-3818
Practice Address - Fax:336-450-4358
Is Sole Proprietor?:No
Enumeration Date:2013-04-30
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
NC10756101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1164623237Medicaid