Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor |
NPI | 1003121104 |
---|---|
Provider Name | Courtney Lesley Washington |
First Address | Fort Wayne, IN 46805-3404 |
Second Address | Fort Wayne, IN 46805-3404 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2010 |
Last Update Date | 24/08/2016 |