Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 9662 | TX |
NPI | 1013001726 |
---|---|
Provider Name | Mr. Edward Lewis Washington |
First Address | Lancaster, TX 75134 |
Second Address | Dallas, TX 75216 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2006 |
Last Update Date | 08/07/2007 |