Provider Demographics
NPI:1669169942
Name:WASHINGTON, BRANDY (LAPC)
Entity type:Individual
Prefix:
First Name:BRANDY
Middle Name:
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:LAPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:718 GREEN ST APT C203
Mailing Address - Street 2:
Mailing Address - City:FORT VALLEY
Mailing Address - State:GA
Mailing Address - Zip Code:31030-4396
Mailing Address - Country:US
Mailing Address - Phone:678-620-6232
Mailing Address - Fax:
Practice Address - Street 1:106 PATRIOT WAY
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-5653
Practice Address - Country:US
Practice Address - Phone:478-333-2182
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-18
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC008526101YM0800X
GALPC013908101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health