Provider Demographics
NPI:1922638907
Name:PHILLIPS-WASHINGTON, LASHAN
Entity Type:Individual
Prefix:
First Name:LASHAN
Middle Name:
Last Name:PHILLIPS-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 1:9336 THUNDERBOLT DR FL 32221
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32221-8023
Mailing Address - Country:US
Mailing Address - Phone:904-233-9627
Mailing Address - Fax:904-212-1340
Practice Address - Street 1:1225 W BEAVER ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204-1414
Practice Address - Country:US
Practice Address - Phone:904-233-9627
Practice Address - Fax:904-212-1340
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-18
Last Update Date:2020-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator