Provider Demographics
NPI:1982865572
Name:WASHINGTON, JAZELLE LYNETTE (LPCC #8715)
Entity Type:Individual
Prefix:
First Name:JAZELLE
Middle Name:LYNETTE
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:LPCC #8715
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:755 S VAN NESS AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-1908
Mailing Address - Country:US
Mailing Address - Phone:415-642-4504
Mailing Address - Fax:415-695-6961
Practice Address - Street 1:755 S VAN NESS AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-1908
Practice Address - Country:US
Practice Address - Phone:415-642-4504
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-17
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8715101YM0800X
CA3373101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health