Provider Demographics
NPI:1700215233
Name:WASHINGTON, QUANINIKA (MS/LADAC/CCDP-D/MFTC)
Entity Type:Individual
Prefix:
First Name:QUANINIKA
Middle Name:
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:MS/LADAC/CCDP-D/MFTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2901 S HEMLOCK ST
Mailing Address - Street 2:
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71603-4783
Mailing Address - Country:US
Mailing Address - Phone:870-489-7002
Mailing Address - Fax:870-850-0001
Practice Address - Street 1:2901 S HEMLOCK ST
Practice Address - Street 2:
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71603-4783
Practice Address - Country:US
Practice Address - Phone:870-489-7002
Practice Address - Fax:870-850-0001
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-05
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR0279L101YA0400X
AR117101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health