Provider Demographics
NPI:1376834887
Name:WASHINGTON, MICHELLE EVETTE (MSW, CATCLLL)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:EVETTE
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:MSW, CATCLLL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1319 SOUTH MANHATTAN PLACE,
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90019
Mailing Address - Country:US
Mailing Address - Phone:323-734-1143
Mailing Address - Fax:323-734-4302
Practice Address - Street 1:1319 S MANHATTAN PL
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90019-4702
Practice Address - Country:US
Practice Address - Phone:323-734-1143
Practice Address - Fax:323-734-4302
Is Sole Proprietor?:No
Enumeration Date:2011-05-02
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2187-1101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor