Provider Demographics
NPI:1811446925
Name:WASHINGTON, LAVADA (LISW)
Entity type:Individual
Prefix:
First Name:LAVADA
Middle Name:
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 MACFALLS WAY
Mailing Address - Street 2:
Mailing Address - City:BLACKLICK
Mailing Address - State:OH
Mailing Address - Zip Code:43004-9491
Mailing Address - Country:US
Mailing Address - Phone:614-668-3890
Mailing Address - Fax:
Practice Address - Street 1:151 MACFALLS WAY
Practice Address - Street 2:
Practice Address - City:BLACKLICK
Practice Address - State:OH
Practice Address - Zip Code:43004-9491
Practice Address - Country:US
Practice Address - Phone:614-668-3890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-30
Last Update Date:2016-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI. 16006331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical