Provider Demographics
NPI:1457926883
Name:WASHINGTON, MINA (MSW)
Entity Type:Individual
Prefix:MRS
First Name:MINA
Middle Name:
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 CUNNINGHAM LN
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37042-5389
Mailing Address - Country:US
Mailing Address - Phone:931-648-5646
Mailing Address - Fax:
Practice Address - Street 1:215 CUNNINGHAM LN
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37042-5389
Practice Address - Country:US
Practice Address - Phone:931-648-5646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-27
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool