Provider Demographics
NPI:1851423768
Name:WASHINGTON, JESSE JR (BA,CAC)
Entity Type:Individual
Prefix:MR
First Name:JESSE
Middle Name:
Last Name:WASHINGTON
Suffix:JR
Gender:M
Credentials:BA,CAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17359 LAHSER RD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48219-2333
Mailing Address - Country:US
Mailing Address - Phone:313-534-3658
Mailing Address - Fax:
Practice Address - Street 1:5470 CHENE ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48211-2746
Practice Address - Country:US
Practice Address - Phone:313-875-5521
Practice Address - Fax:313-267-0549
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)