Provider Demographics
NPI:1215106513
Name:WASHINGTON, EDNA M (BSHS)
Entity type:Individual
Prefix:MS
First Name:EDNA
Middle Name:M
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:BSHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11811 CLIFFROSE CT
Mailing Address - Street 2:
Mailing Address - City:ADELANTO
Mailing Address - State:CA
Mailing Address - Zip Code:92301-3781
Mailing Address - Country:US
Mailing Address - Phone:760-246-4284
Mailing Address - Fax:760-244-8776
Practice Address - Street 1:11811 CLIFFROSE CT
Practice Address - Street 2:
Practice Address - City:ADELANTO
Practice Address - State:CA
Practice Address - Zip Code:92301-3781
Practice Address - Country:US
Practice Address - Phone:760-246-4284
Practice Address - Fax:760-244-8776
Is Sole Proprietor?:No
Enumeration Date:2008-02-21
Last Update Date:2014-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1215106513Medicaid
CA101YM0800XMedicaid
CA101YA0400XMedicaid