Provider Demographics
NPI:1427224229
Name:WASHINGTON, GREG
Entity Type:Individual
Prefix:
First Name:GREG
Middle Name:
Last Name:WASHINGTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6236 BELLE AVE
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90620-4321
Mailing Address - Country:US
Mailing Address - Phone:714-527-7046
Mailing Address - Fax:
Practice Address - Street 1:17420 AVALON BLVD
Practice Address - Street 2:200
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90746-1564
Practice Address - Country:US
Practice Address - Phone:323-759-3464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-01
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)