Provider Demographics
NPI:1629853452
Name:WASHINGTON, MARVIN JEROME (LPC, NCC)
Entity Type:Individual
Prefix:MR
First Name:MARVIN
Middle Name:JEROME
Last Name:WASHINGTON
Suffix:
Gender:M
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5750 CEDAR SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75235-6802
Mailing Address - Country:US
Mailing Address - Phone:214-393-3640
Mailing Address - Fax:214-261-2317
Practice Address - Street 1:5750 CEDAR SPRINGS RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-6802
Practice Address - Country:US
Practice Address - Phone:214-393-3640
Practice Address - Fax:214-261-2317
Is Sole Proprietor?:No
Enumeration Date:2023-08-29
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX86956101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health