Provider Demographics
NPI:1023864485
Name:WASHINGTON, QUINCY (CPT, CSNC,WLS, CWC)
Entity type:Individual
Prefix:
First Name:QUINCY
Middle Name:
Last Name:WASHINGTON
Suffix:
Gender:M
Credentials:CPT, CSNC,WLS, CWC
Other - Prefix:
Other - First Name:QUINCY
Other - Middle Name:
Other - Last Name:WASHINGTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:YES
Mailing Address - Street 1:208 GOLDEN EAGLE WAY
Mailing Address - Street 2:
Mailing Address - City:BELCAMP
Mailing Address - State:MD
Mailing Address - Zip Code:21017-1536
Mailing Address - Country:US
Mailing Address - Phone:443-866-3223
Mailing Address - Fax:
Practice Address - Street 1:208 GOLDEN EAGLE WAY
Practice Address - Street 2:
Practice Address - City:BELCAMP
Practice Address - State:MD
Practice Address - Zip Code:21017-1536
Practice Address - Country:US
Practice Address - Phone:443-866-3223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-26
Last Update Date:2024-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1231038542171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach
Provider Identifiers
StateIdentifier IDID TypeIssuer
W24985061OtherSTATE LICENSE