Provider Demographics
NPI:1598000820
Name:WASHINGTON-ANDERSON, TINA (LPC)
Entity Type:Individual
Prefix:MRS
First Name:TINA
Middle Name:
Last Name:WASHINGTON-ANDERSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:542 SPRING HILL DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-8671
Mailing Address - Country:US
Mailing Address - Phone:601-497-8468
Mailing Address - Fax:
Practice Address - Street 1:542 SPRING HILL DR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:MS
Practice Address - Zip Code:39110-8671
Practice Address - Country:US
Practice Address - Phone:601-497-8468
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-27
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1672101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health