Healthcare Provider Details

I. General information

NPI: 1518882125
Provider Name (Legal Business Name): MICHELLE L WASHINGTON PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 MARGARET AVE NE
MARIETTA GA
30060-1306
US

IV. Provider business mailing address

2551 HADDENHAM LN SW
SMYRNA GA
30082-3677
US

V. Phone/Fax

Practice location:
  • Phone: 770-352-9952
  • Fax:
Mailing address:
  • Phone: 630-235-3036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY900325
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number4132
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: