Provider Demographics
NPI:1497312730
Name:WASHINGTON, TERESA LAVON
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:LAVON
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 1:801 N 31ST ST STE 1
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-3947
Mailing Address - Country:US
Mailing Address - Phone:318-737-7794
Mailing Address - Fax:318-605-4800
Practice Address - Street 1:801 N 31ST ST STE 1
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-3947
Practice Address - Country:US
Practice Address - Phone:318-737-7794
Practice Address - Fax:318-605-4800
Is Sole Proprietor?:No
Enumeration Date:2019-05-22
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator