Provider Demographics
NPI:1922573849
Name:WASHINGTON, RANDI SADE'
Entity Type:Individual
Prefix:MS
First Name:RANDI
Middle Name:SADE'
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 1:347 PEGASUS ST
Mailing Address - Street 2:
Mailing Address - City:NATCHITOCHES
Mailing Address - State:LA
Mailing Address - Zip Code:71457-5009
Mailing Address - Country:US
Mailing Address - Phone:318-652-7748
Mailing Address - Fax:
Practice Address - Street 1:830 4TH ST
Practice Address - Street 2:
Practice Address - City:NATCHITOCHES
Practice Address - State:LA
Practice Address - Zip Code:71457-4569
Practice Address - Country:US
Practice Address - Phone:318-214-4002
Practice Address - Fax:318-214-4004
Is Sole Proprietor?:No
Enumeration Date:2018-10-07
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA7210101YM0800X, 171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health