Provider Demographics
NPI:1700111077
Name:WASHINGTON, ANTHYONETTE ROYCE (MS)
Entity Type:Individual
Prefix:MS
First Name:ANTHYONETTE
Middle Name:ROYCE
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 BRUSH ST
Mailing Address - Street 2:SUITE 805
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48226-4348
Mailing Address - Country:US
Mailing Address - Phone:313-965-6118
Mailing Address - Fax:
Practice Address - Street 1:555 BRUSH ST
Practice Address - Street 2:SUITE 805
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48226-4348
Practice Address - Country:US
Practice Address - Phone:313-965-6118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-05
Last Update Date:2009-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NONE101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)