Provider Demographics
NPI:1912331794
Name:WASHINGTON, CAROL R (MS/LCAC)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:R
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:MS/LCAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 N 12TH ST
Mailing Address - Street 2:SUITE 470
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66102-5161
Mailing Address - Country:US
Mailing Address - Phone:913-371-0352
Mailing Address - Fax:
Practice Address - Street 1:21 N 12TH ST
Practice Address - Street 2:SUITE 470
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66102-5161
Practice Address - Country:US
Practice Address - Phone:913-371-0352
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-28
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS446101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)