Provider Demographics
NPI:1972839728
Name:WASHINGTON, ALICE ANN MARIE (LCSW)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:ANN MARIE
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 577824
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95357-7824
Mailing Address - Country:US
Mailing Address - Phone:209-996-9127
Mailing Address - Fax:
Practice Address - Street 1:1349 MAIN ST
Practice Address - Street 2:
Practice Address - City:NEWMAN
Practice Address - State:CA
Practice Address - Zip Code:95360-1326
Practice Address - Country:US
Practice Address - Phone:209-862-3604
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-29
Last Update Date:2010-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical