Provider Demographics
NPI:1396122214
Name:WASHINGTON, JACKEY ROCHELE (LPCC)
Entity type:Individual
Prefix:MRS
First Name:JACKEY
Middle Name:ROCHELE
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7802 SUNDANCE DR
Mailing Address - Street 2:APT H
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-4741
Mailing Address - Country:US
Mailing Address - Phone:270-403-6622
Mailing Address - Fax:
Practice Address - Street 1:7802 SUNDANCE DR
Practice Address - Street 2:APT H
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-4741
Practice Address - Country:US
Practice Address - Phone:270-403-6622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-29
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY171970101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional