Provider Demographics
NPI:1013481720
Name:WASHINGTON, DOROTHY
Entity type:Individual
Prefix:
First Name:DOROTHY
Middle Name:
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 1:6316 SAN JUAN AVE STE 41A
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32210-2883
Mailing Address - Country:US
Mailing Address - Phone:904-503-1153
Mailing Address - Fax:904-503-1143
Practice Address - Street 1:6316 SAN JUAN AVE STE 41A
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210-2883
Practice Address - Country:US
Practice Address - Phone:904-503-1153
Practice Address - Fax:904-503-1143
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-15
Last Update Date:2022-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL83-0766373Medicaid