Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor |
NPI | 1003243791 |
---|---|
Provider Name | Ms. Denita Washington |
First Address | Roxbury, MA 02119 |
Second Address | Roxbury, MA 02119 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2013 |
Last Update Date | 26/09/2013 |