Provider Demographics
NPI:1104086933
Name:WASHINGTON, JACQUELYN AGNES (LCSW-BACS)
Entity type:Individual
Prefix:MRS
First Name:JACQUELYN
Middle Name:AGNES
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:LCSW-BACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6636
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70174-6636
Mailing Address - Country:US
Mailing Address - Phone:504-427-1582
Mailing Address - Fax:504-393-0558
Practice Address - Street 1:2495 SHREVEPORT HWY 71 NORTH
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71306-9004
Practice Address - Country:US
Practice Address - Phone:318-473-0010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-16
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA11541041C0700X
LA1944C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical