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General NPI Number Information
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NPI Number | 1225688724
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Entity Type | Individual
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Provider Name | ANGELICA WASHINGTON
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Gender | Female
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Dates
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Enumeration Date | 09/17/2019
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Last Update Date | 12/28/2023
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Provider Practice Location Address
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Address Line | 1551 GARDEN ST
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City | TITUSVILLE
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State | FL
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Zip | 32796-3269
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Country | US
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Telephone | 440-654-5125
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Fax |
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Provider Business Mailing Address
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Address Line | 3380 MELODY LN
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City | TITUSVILLE
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State | FL
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Zip | 32796-4249
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Country | US
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Telephone |
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-19-97695
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LMH22663
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License Number State | FL
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