MEDICARE: S. WASHINGTON, LLC

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	251S00000X	Community/Behavioral Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1992292627
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	S. WASHINGTON, LLC

Provider Business Mailing Address
First Line	:	PO BOX 3715
Second Line	:
City	:	CHESTER
State	:	VA
Zip	:	23831-8468
Country	:	US
Telephone Number	:	302-593-3487
Fax Number	:	804-251-1416

Provider Business Practice Location Address
First Line	:	3606 BOULEVARD STE D
Second Line	:
City	:	COLONIAL HEIGHTS
State	:	VA
Zip	:	23834-1341
Country	:	US
Telephone Number	:	302-593-3487
Fax Number	:	804-251-1416

Authorized Official
Title or Position	:	OWNER
Name	:	SHARDAE WASHINGTON
Credential	:	LMFT
Telephone Number	:	302-593-3487

Provider Enumeration Date	:	04/18/2018
Last Update Date	:	04/18/2018

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