MEDICARE: MARVANISHA Y WASHINGTON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1942821418
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARVANISHA Y WASHINGTON

Provider Business Mailing Address
First Line	:	1903 PHOENIX BLVD STE 200
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30349-5700
Country	:	US
Telephone Number	:	832-638-2968
Fax Number	:

Provider Business Practice Location Address
First Line	:	1903 PHOENIX BLVD STE 200
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30349-5700
Country	:	US
Telephone Number	:	678-335-9010
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/06/2020
Last Update Date	:	05/06/2020

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