Provider Demographics
NPI:1275299398
Name:WASHINGTON, CHARDONNEY LA'SHAI (LPC)
Entity Type:Individual
Prefix:
First Name:CHARDONNEY
Middle Name:LA'SHAI
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 BROOKHILL CIR
Mailing Address - Street 2:
Mailing Address - City:PELL CITY
Mailing Address - State:AL
Mailing Address - Zip Code:35125-1392
Mailing Address - Country:US
Mailing Address - Phone:478-273-1187
Mailing Address - Fax:
Practice Address - Street 1:2101 BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35904-4715
Practice Address - Country:US
Practice Address - Phone:205-615-1445
Practice Address - Fax:205-558-8555
Is Sole Proprietor?:No
Enumeration Date:2021-11-12
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALALC03889101Y00000X
ALLPC05028101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor