Provider Demographics
NPI:1841656394
Name:WASHINGTON, WILLIAM CLARENCE
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:CLARENCE
Last Name:WASHINGTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 19425
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44119-0425
Mailing Address - Country:US
Mailing Address - Phone:865-773-9632
Mailing Address - Fax:216-486-8147
Practice Address - Street 1:814 E 185TH ST STE 300
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44119-2775
Practice Address - Country:US
Practice Address - Phone:166-819-2642
Practice Address - Fax:216-282-8596
Is Sole Proprietor?:No
Enumeration Date:2016-01-13
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.2102105101YM0800X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0410706Medicaid