Provider Demographics
NPI:1851735070
Name:WASHINGTON, CHANDREA NICHOLE
Entity Type:Individual
Prefix:
First Name:CHANDREA
Middle Name:NICHOLE
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1021 E BROOKS ST
Mailing Address - Street 2:APT. G
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73071-3416
Mailing Address - Country:US
Mailing Address - Phone:510-978-2418
Mailing Address - Fax:
Practice Address - Street 1:1021 E BROOKS ST
Practice Address - Street 2:APT. G
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73071-3416
Practice Address - Country:US
Practice Address - Phone:510-978-2418
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-18
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor