Provider Demographics
NPI:1720718125
Name:WASHINGTON, LATASCHA PATRICE (LCSW-C)
Entity Type:Individual
Prefix:
First Name:LATASCHA
Middle Name:PATRICE
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:TASCHA
Other - Middle Name:
Other - Last Name:WASHINGTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW-C
Mailing Address - Street 1:12109 POND PINE DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20871-4473
Mailing Address - Country:US
Mailing Address - Phone:253-448-7036
Mailing Address - Fax:
Practice Address - Street 1:12109 POND PINE DR
Practice Address - Street 2:
Practice Address - City:CLARKSBURG
Practice Address - State:MD
Practice Address - Zip Code:20871-4473
Practice Address - Country:US
Practice Address - Phone:253-448-7036
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-16
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW159561041C0700X
MD252561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical