Provider Demographics
NPI:1538465042
Name:WASHINGTON, CHARLES JR (MFTI)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:
Last Name:WASHINGTON
Suffix:JR
Gender:M
Credentials:MFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 MYRTLE ST STE 102
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94607-2535
Mailing Address - Country:US
Mailing Address - Phone:510-663-3880
Mailing Address - Fax:
Practice Address - Street 1:111 MYRTLE ST STE 102
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94607-2535
Practice Address - Country:US
Practice Address - Phone:510-663-3880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-31
Last Update Date:2011-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA65848106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist