Provider Demographics
NPI:1265634406
Name:WASHINGTON, TAQUELIA (ACSW #18925, PPS)
Entity Type:Individual
Prefix:
First Name:TAQUELIA
Middle Name:
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:ACSW #18925, PPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39155 LIBERTY ST
Mailing Address - Street 2:SUITE E500
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-1513
Mailing Address - Country:US
Mailing Address - Phone:510-574-2117
Mailing Address - Fax:510-574-2105
Practice Address - Street 1:39155 LIBERTY ST
Practice Address - Street 2:SUITE E500
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1513
Practice Address - Country:US
Practice Address - Phone:510-574-2117
Practice Address - Fax:510-574-2105
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18925104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker