Provider Demographics
NPI:1952670986
Name:WASHINGTON, TANGIE M (ACSW)
Entity Type:Individual
Prefix:MRS
First Name:TANGIE
Middle Name:M
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5050 LAGUNA BLVD
Mailing Address - Street 2:STE 112 PMB 402
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-4151
Mailing Address - Country:US
Mailing Address - Phone:916-324-4218
Mailing Address - Fax:
Practice Address - Street 1:1515 S ST
Practice Address - Street 2:STE 212N
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95811-7243
Practice Address - Country:US
Practice Address - Phone:916-715-1184
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-20
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW248111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical