Provider Demographics
NPI:1295226009
Name:WASH, KATHRYN B (EDS)
Entity type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:B
Last Name:WASH
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:953 DAVIS HWY
Mailing Address - Street 2:
Mailing Address - City:MINERAL
Mailing Address - State:VA
Mailing Address - Zip Code:23117-4149
Mailing Address - Country:US
Mailing Address - Phone:540-894-5115
Mailing Address - Fax:540-967-0337
Practice Address - Street 1:953 DAVIS HWY
Practice Address - Street 2:
Practice Address - City:MINERAL
Practice Address - State:VA
Practice Address - Zip Code:23117-4149
Practice Address - Country:US
Practice Address - Phone:540-894-5115
Practice Address - Fax:540-967-0337
Is Sole Proprietor?:No
Enumeration Date:2018-05-29
Last Update Date:2018-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09-330959103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0813000174Medicaid