Healthcare Provider Details

I. General information

NPI: 1588895072
Provider Name (Legal Business Name): SAMANTHA WASHINGTON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2009
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 LANCASHIRE DR S
JACKSONVILLE FL
32219
US

IV. Provider business mailing address

103 LANCASHIRE DR S
JACKSONVILLE FL
32219
US

V. Phone/Fax

Practice location:
  • Phone: 404-623-5188
  • Fax:
Mailing address:
  • Phone: 404-623-5188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number253247
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: