Provider Demographics
NPI:1669881942
Name:WASHINGTON, KATRINA
Entity type:Individual
Prefix:
First Name:KATRINA
Middle Name:
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6355 PARAKEET TRL
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-7097
Mailing Address - Country:US
Mailing Address - Phone:850-525-7733
Mailing Address - Fax:
Practice Address - Street 1:6355 PARAKEET TRL
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-7097
Practice Address - Country:US
Practice Address - Phone:850-525-7733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-12
Last Update Date:2014-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No251S00000XAgenciesCommunity/Behavioral Health
No305R00000XManaged Care OrganizationsPreferred Provider Organization