Provider Demographics
NPI:1336733005
Name:WASHINGTON, CONSTANCE NMN
Entity Type:Individual
Prefix:MRS
First Name:CONSTANCE
Middle Name:NMN
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NONE
Other - Middle Name:NMN
Other - Last Name:DUNCAN, JACKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:410 E 61ST ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98404-1929
Mailing Address - Country:US
Mailing Address - Phone:253-376-0653
Mailing Address - Fax:206-363-9639
Practice Address - Street 1:410 E 61ST ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98404-1929
Practice Address - Country:US
Practice Address - Phone:253-376-0653
Practice Address - Fax:206-363-9639
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-23
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60599340101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional