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General NPI Number Information
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NPI Number | 1104086933
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Entity Type | Individual
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Provider Name | JACQUELYN AGNES WASHINGTON LCSW-BACS
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Gender | Female
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Dates
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Enumeration Date | 06/16/2008
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Last Update Date | 06/16/2008
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Provider Practice Location Address
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Address Line | 2495 SHREVEPORT HWY 71 NORTH
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City | ALEXANDRIA
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State | LA
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Zip | 71306-9004
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Country | US
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Telephone | 318-473-0010
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 6636
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City | NEW ORLEANS
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State | LA
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Zip | 70174-6636
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Country | US
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Telephone | 504-427-1582
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Fax | 504-393-0558
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 1154
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 1944C
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License Number State | LA
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