Provider Demographics
NPI:1477272425
Name:WASHINGTON, NICOLE ELIZABETH
Entity Type:Individual
Prefix:MISS
First Name:NICOLE
Middle Name:ELIZABETH
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13415 ELLIS ST
Mailing Address - Street 2:
Mailing Address - City:VACHERIE
Mailing Address - State:LA
Mailing Address - Zip Code:70090-3261
Mailing Address - Country:US
Mailing Address - Phone:504-357-9857
Mailing Address - Fax:
Practice Address - Street 1:623 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:LA
Practice Address - Zip Code:70053-2115
Practice Address - Country:US
Practice Address - Phone:504-571-5223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-23
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health