Healthcare Provider Details

I. General information

NPI: 1174380760
Provider Name (Legal Business Name): LESLIE A WASHINGTON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/29/2024
Last Update Date: 02/29/2024
Certification Date: 02/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9000 LOTT CARY RD
PROVIDENCE FORGE VA
23140-2358
US

IV. Provider business mailing address

9000 LOTT CARY RD
PROVIDENCE FORGE VA
23140-2358
US

V. Phone/Fax

Practice location:
  • Phone: 804-482-9010
  • Fax:
Mailing address:
  • Phone: 804-482-9010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: