Provider Demographics
NPI:1093562571
Name:WASHINGTON, ALYSSA CHANELL (BEHAVIOR TECHNICIAN)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:CHANELL
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:BEHAVIOR TECHNICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19540 AMARANTH DR
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20874-1202
Mailing Address - Country:US
Mailing Address - Phone:301-704-6486
Mailing Address - Fax:
Practice Address - Street 1:19540 AMARANTH DR
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20874-1202
Practice Address - Country:US
Practice Address - Phone:301-704-6486
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-02
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician