Provider Demographics
NPI:1215769740
Name:WASHINGTON, DENETRA YVONNE (MSW, GERONTOLOGY)
Entity type:Individual
Prefix:
First Name:DENETRA
Middle Name:YVONNE
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:MSW, GERONTOLOGY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:735 PENNYWELL CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229-8439
Mailing Address - Country:US
Mailing Address - Phone:803-261-8101
Mailing Address - Fax:
Practice Address - Street 1:735 PENNYWELL CT
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29229-8439
Practice Address - Country:US
Practice Address - Phone:803-261-8101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-14
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker