Provider Demographics
NPI:1891411591
Name:WASHINGTON, LATOYA JOI (AMFT)
Entity Type:Individual
Prefix:
First Name:LATOYA
Middle Name:JOI
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3705 HAVEN AVE STE 134
Mailing Address - Street 2:
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-1011
Mailing Address - Country:US
Mailing Address - Phone:650-667-0117
Mailing Address - Fax:
Practice Address - Street 1:2624 W BILLINGS ST
Practice Address - Street 2:
Practice Address - City:COMPTON
Practice Address - State:CA
Practice Address - Zip Code:90220-3908
Practice Address - Country:US
Practice Address - Phone:619-851-2375
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-13
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA130519106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA86-1922789Medicaid