Provider Demographics
NPI:1801284005
Name:WASHINGTON, OTIS (LCSW)
Entity type:Individual
Prefix:
First Name:OTIS
Middle Name:
Last Name:WASHINGTON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1602 FOREST AVE NW
Mailing Address - Street 2:
Mailing Address - City:FORT PAYNE
Mailing Address - State:AL
Mailing Address - Zip Code:35967-3324
Mailing Address - Country:US
Mailing Address - Phone:256-630-0156
Mailing Address - Fax:256-638-1854
Practice Address - Street 1:1602 FOREST AVE NW
Practice Address - Street 2:
Practice Address - City:FORT PAYNE
Practice Address - State:AL
Practice Address - Zip Code:35967-3324
Practice Address - Country:US
Practice Address - Phone:256-630-0156
Practice Address - Fax:256-638-1854
Is Sole Proprietor?:No
Enumeration Date:2014-12-23
Last Update Date:2014-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3685C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical