Provider Demographics
NPI:1992292627
Name:S. WASHINGTON, LLC
Entity type:Organization
Organization Name:S. WASHINGTON, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHARDAE
Authorized Official - Middle Name:
Authorized Official - Last Name:WASHINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:302-593-3487
Mailing Address - Street 1:PO BOX 3715
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23831-8468
Mailing Address - Country:US
Mailing Address - Phone:302-593-3487
Mailing Address - Fax:804-251-1416
Practice Address - Street 1:3606 BOULEVARD STE D
Practice Address - Street 2:
Practice Address - City:COLONIAL HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:23834-1341
Practice Address - Country:US
Practice Address - Phone:302-593-3487
Practice Address - Fax:804-251-1416
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-18
Last Update Date:2018-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1568865855Medicaid