Provider Demographics
NPI:1063887784
Name:WASHINGTON, ELLIOTT (MA, BCCC)
Entity type:Individual
Prefix:
First Name:ELLIOTT
Middle Name:
Last Name:WASHINGTON
Suffix:
Gender:M
Credentials:MA, BCCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3950 COBB PKWY NW STE 902
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101-9525
Mailing Address - Country:US
Mailing Address - Phone:800-910-5060
Mailing Address - Fax:800-634-6360
Practice Address - Street 1:3950 COBB PKWY NW STE 902
Practice Address - Street 2:
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30101-9525
Practice Address - Country:US
Practice Address - Phone:800-910-5060
Practice Address - Fax:800-634-6360
Is Sole Proprietor?:No
Enumeration Date:2015-12-07
Last Update Date:2015-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0608101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional