Healthcare Provider Details

I. General information

NPI: 1003761248
Provider Name (Legal Business Name): CHRISTOPHER WASHINGTON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2026
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20302 FLANAGAN ROAD
TRABUCO CANYON CA
92679
US

IV. Provider business mailing address

PO BOX 740780
ATLANTA GA
30374-0780
US

V. Phone/Fax

Practice location:
  • Phone: 818-582-8832
  • Fax: 818-582-8836
Mailing address:
  • Phone: 855-223-7123
  • Fax: 855-223-7123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberRT1446180626
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: