Provider Demographics
NPI:1982403473
Name:WASHINGTON, MARKSTONE
Entity type:Individual
Prefix:
First Name:MARKSTONE
Middle Name:
Last Name:WASHINGTON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 SABINE RIVER RD
Mailing Address - Street 2:
Mailing Address - City:GLENN HEIGHTS
Mailing Address - State:TX
Mailing Address - Zip Code:75154-5582
Mailing Address - Country:US
Mailing Address - Phone:469-744-6559
Mailing Address - Fax:
Practice Address - Street 1:700 W MAIN ST STE 3
Practice Address - Street 2:
Practice Address - City:OVILLA
Practice Address - State:TX
Practice Address - Zip Code:75154-1681
Practice Address - Country:US
Practice Address - Phone:469-744-6559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-10
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty