Provider Demographics
NPI:1891543856
Name:WASHINGTON, MIANA
Entity type:Individual
Prefix:
First Name:MIANA
Middle Name:
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7215 WESTSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48917-9764
Mailing Address - Country:US
Mailing Address - Phone:517-657-2638
Mailing Address - Fax:248-711-2438
Practice Address - Street 1:7215 WESTSHIRE DR
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48917-9764
Practice Address - Country:US
Practice Address - Phone:517-657-2638
Practice Address - Fax:248-711-2438
Is Sole Proprietor?:No
Enumeration Date:2024-05-07
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician