Provider Demographics
NPI:1811606528
Name:WASHINGTON, DEVANTE RAE (ED S)
Entity type:Individual
Prefix:
First Name:DEVANTE
Middle Name:RAE
Last Name:WASHINGTON
Suffix:
Gender:M
Credentials:ED S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2751 BUFORD HWY NE STE 700
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30324-5510
Mailing Address - Country:US
Mailing Address - Phone:404-948-6975
Mailing Address - Fax:404-795-0602
Practice Address - Street 1:2751 BUFORD HWY NE STE 700
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30324-5510
Practice Address - Country:US
Practice Address - Phone:404-948-6975
Practice Address - Fax:404-795-0602
Is Sole Proprietor?:No
Enumeration Date:2022-11-21
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional