Provider Demographics
NPI:1619278215
Name:WASHINGTON, KEVIN (PHD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:
Last Name:WASHINGTON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 E PLANT ST
Mailing Address - Street 2:101
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-3133
Mailing Address - Country:US
Mailing Address - Phone:407-490-6511
Mailing Address - Fax:
Practice Address - Street 1:314 E PLANT ST
Practice Address - Street 2:101
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-3133
Practice Address - Country:US
Practice Address - Phone:407-490-6511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-12
Last Update Date:2013-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY8137103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling