Provider Demographics
NPI:1306296462
Name:WASHINGTON, MCKEISHA
Entity type:Individual
Prefix:
First Name:MCKEISHA
Middle Name:
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:289 JONESBORO RD
Mailing Address - Street 2:P.O. BOX 505
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-3725
Mailing Address - Country:US
Mailing Address - Phone:770-687-9445
Mailing Address - Fax:
Practice Address - Street 1:289 JONESBORO RD
Practice Address - Street 2:505
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-3725
Practice Address - Country:US
Practice Address - Phone:770-687-9445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-20
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty