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General NPI Number Information
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NPI Number | 1306294707
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Entity Type | Individual
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Provider Name | MS. KISSIE SHANTA WASHINGTON
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Gender | Female
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Dates
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Enumeration Date | 05/26/2016
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Last Update Date | 12/28/2025
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Provider Practice Location Address
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Address Line | 15476 ARCHDALE ST
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City | DETROIT
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State | MI
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Zip | 48227-1506
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Country | US
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Telephone | 248-249-3497
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Fax |
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Provider Business Mailing Address
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Address Line | 15476 ARCHDALE ST
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City | DETROIT
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State | MI
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Zip | 48227-1506
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Country | US
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Telephone | 248-249-3497
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 385HR2060X
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Taxonomy Name | Child Intellectual and/or Developmental Disabilities Respite Care
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License Number |
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 247200000X
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Taxonomy Name | Other Technician
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License Number |
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License Number State | MI
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Taxonomy #4
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Taxonomy Code | 385HR2060X
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Taxonomy Name | Child Intellectual and/or Developmental Disabilities Respite Care
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License Number |
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License Number State | MI
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Taxonomy #5
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Taxonomy Code | 385HR2065X
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Taxonomy Name | Child Physical Disabilities Respite Care
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License Number |
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License Number State | OH
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Taxonomy #6
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Taxonomy Code | 385HR2055X
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Taxonomy Name | Child Mental Illness Respite Care
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License Number |
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License Number State | OH
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Taxonomy #7
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Taxonomy Code | 385HR2065X
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Taxonomy Name | Child Physical Disabilities Respite Care
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License Number |
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License Number State | MI
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Taxonomy #8
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Taxonomy Code | 385HR2055X
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Taxonomy Name | Child Mental Illness Respite Care
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License Number |
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License Number State | MI
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