=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275299398
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHARDONNEY LA'SHAI WASHINGTON LPC, NCC, CRC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/12/2021
-----------------------------------------------------
Last Update Date | 08/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2101 BROADWAY AVE
-----------------------------------------------------
City | GADSDEN
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35904-4715
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-615-1445
-----------------------------------------------------
Fax | 205-558-8555
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 108 LA CLAIRE DR APT D
-----------------------------------------------------
City | WARNER ROBINS
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31088-3621
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 478-273-1187
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number | ALC03889
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | LPC05028
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------