Healthcare Provider Details

I. General information

NPI: 1114698800
Provider Name (Legal Business Name): CHARLONDA WASHINGTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2021
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 BLUEJAY ST
CLAYTON NC
27520-3865
US

IV. Provider business mailing address

308 BLUEJAY ST
CLAYTON NC
27520-3865
US

V. Phone/Fax

Practice location:
  • Phone: 919-836-3433
  • Fax:
Mailing address:
  • Phone: 919-836-3433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP023157
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: