Provider Demographics
NPI:1699927095
Name:DYSON-WASHINGTON, FAITH VAL (PHD)
Entity type:Individual
Prefix:DR
First Name:FAITH
Middle Name:VAL
Last Name:DYSON-WASHINGTON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2005 MARKET ST
Mailing Address - Street 2:SUITE 3140
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-7042
Mailing Address - Country:US
Mailing Address - Phone:215-636-9797
Mailing Address - Fax:215-636-9979
Practice Address - Street 1:2005 MARKET ST
Practice Address - Street 2:SUITE 3140
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-7042
Practice Address - Country:US
Practice Address - Phone:215-636-9797
Practice Address - Fax:215-636-9979
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-16
Last Update Date:2015-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS017207103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical