Provider Demographics
NPI:1881154326
Name:WASHINGTON, DESIREE R (LICSW, LCSW-C)
Entity type:Individual
Prefix:
First Name:DESIREE
Middle Name:R
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:LICSW, LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13206 IDLEWILD DR
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20715-1406
Mailing Address - Country:US
Mailing Address - Phone:216-965-4495
Mailing Address - Fax:240-245-4663
Practice Address - Street 1:13206 IDLEWILD DR
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20715-1406
Practice Address - Country:US
Practice Address - Phone:216-965-4495
Practice Address - Fax:240-245-4663
Is Sole Proprietor?:No
Enumeration Date:2019-03-21
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC500783731041C0700X
MD135931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical