Provider Demographics
NPI:1932573938
Name:WASHINGTON, CHESTINE DANIELLE
Entity Type:Individual
Prefix:
First Name:CHESTINE
Middle Name:DANIELLE
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3191 MEDICAL CENTER DR APT 21202
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75069-1689
Mailing Address - Country:US
Mailing Address - Phone:214-927-5082
Mailing Address - Fax:
Practice Address - Street 1:3191 MEDICAL CENTER DR APT 21202
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75069-1689
Practice Address - Country:US
Practice Address - Phone:214-927-5082
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-15
Last Update Date:2015-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX47-5452058OtherBLUE CROSS BLUE SHIELD