Provider Demographics
NPI:1558109470
Name:WASHINGTON, KALEB MICHAEL
Entity type:Individual
Prefix:
First Name:KALEB
Middle Name:MICHAEL
Last Name:WASHINGTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9902 FOX RUN DR
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-3071
Mailing Address - Country:US
Mailing Address - Phone:301-836-8161
Mailing Address - Fax:
Practice Address - Street 1:4202 FORT DUPONT ST SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-6035
Practice Address - Country:US
Practice Address - Phone:202-575-4848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-16
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral