Healthcare Provider Details

I. General information

NPI: 1508100454
Provider Name (Legal Business Name): KIANA MARIE WASHINGTON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2012
Last Update Date: 12/19/2024
Certification Date: 12/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

429 W AIRLINE HWY STE U
LA PLACE LA
70068-3817
US

IV. Provider business mailing address

166 TUSCANY DR
LA PLACE LA
70068-8412
US

V. Phone/Fax

Practice location:
  • Phone: 985-224-3691
  • Fax: 504-544-0223
Mailing address:
  • Phone: 985-210-6487
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6336
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6336
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: