Provider Demographics
NPI:1124272083
Name:WASHINGTON, SHELIAAND DIEDRE
Entity type:Individual
Prefix:
First Name:SHELIAAND
Middle Name:DIEDRE
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHELIAAND
Other - Middle Name:DIEDRE
Other - Last Name:HARDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:108 MARBUN RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-4009
Mailing Address - Country:US
Mailing Address - Phone:803-788-6881
Mailing Address - Fax:
Practice Address - Street 1:1125 CARTER STREET
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204
Practice Address - Country:US
Practice Address - Phone:803-786-1183
Practice Address - Fax:803-735-1021
Is Sole Proprietor?:No
Enumeration Date:2008-11-05
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health