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General NPI Number Information
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NPI Number | 1134880263
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Entity Type | Individual
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Provider Name | MAYA DIANE WASHINGTON B.A, M.A.
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Gender | Female
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Dates
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Enumeration Date | 12/30/2021
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Last Update Date | 12/30/2021
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Provider Practice Location Address
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Address Line | 8110 POCKET RD STE 102
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City | SACRAMENTO
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State | CA
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Zip | 95831-5829
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Country | US
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Telephone | 916-245-0715
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Fax |
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Provider Business Mailing Address
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Address Line | 127 MAIN ST APT 3
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City | WOODLAND
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State | CA
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Zip | 95695-3165
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Country | US
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Telephone | 310-753-5854
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Fax |
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 130079
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License Number State | CA
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