Provider Demographics
NPI:1871183749
Name:WASHINGTON, DENISA
Entity Type:Individual
Prefix:
First Name:DENISA
Middle Name:
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DENISCA
Other - Middle Name:
Other - Last Name:WASHINGTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:4422 PACK SADDLE PASS STE 102
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-1644
Mailing Address - Country:US
Mailing Address - Phone:929-430-6444
Mailing Address - Fax:
Practice Address - Street 1:4422 PACK SADDLE PASS STE 102
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-1644
Practice Address - Country:US
Practice Address - Phone:929-430-6444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-24
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional