Provider Demographics
NPI:1376130229
Name:WASHINGTON, MARCELINA MICHELL (LPC, LCDC, NCC)
Entity Type:Individual
Prefix:MS
First Name:MARCELINA
Middle Name:MICHELL
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:LPC, LCDC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10190 KATY FWY STE 555E
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77043-5236
Mailing Address - Country:US
Mailing Address - Phone:346-291-3515
Mailing Address - Fax:
Practice Address - Street 1:10190 KATY FWY STE 555E
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77043-5236
Practice Address - Country:US
Practice Address - Phone:281-883-2222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-27
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13746101YA0400X
TX82020101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX88-0664026OtherOXFORD
TX88-0664026Medicaid
TX88-0664026OtherCIGNA
TX88-0664026OtherOSCAR HEALTH
TX88-0664026OtherBLUE CROSS BLUE SHIELD- TX
TX88-0664026OtherUNITED HEALTHCARE
TX88-0664026OtherAETNA
TX88-0664026OtherOPTIMUM