Provider Demographics
NPI:1316293665
Name:WASHINGTON, COURTNEY Y (EDD, LPC)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:Y
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:EDD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23240 S BROOKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:DEARBORN HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48125-2321
Mailing Address - Country:US
Mailing Address - Phone:313-949-2624
Mailing Address - Fax:
Practice Address - Street 1:22456 S KANE ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48223-2541
Practice Address - Country:US
Practice Address - Phone:419-378-1969
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-24
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401011384101YM0800X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health