Provider Demographics
NPI:1023323946
Name:WASHINGTON, LEON JR (PHD, LCPC)
Entity type:Individual
Prefix:DR
First Name:LEON
Middle Name:
Last Name:WASHINGTON
Suffix:JR
Gender:M
Credentials:PHD, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3403 NEWPORT AVE
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21403-4800
Mailing Address - Country:US
Mailing Address - Phone:410-626-0061
Mailing Address - Fax:
Practice Address - Street 1:92 W WASHINGTON ST
Practice Address - Street 2:2
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-2432
Practice Address - Country:US
Practice Address - Phone:410-626-1800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-16
Last Update Date:2010-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC1154101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDLC1154OtherMARYLAND STATE LICENSE