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General NPI Number Information
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NPI Number | 1316293665
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Entity Type | Individual
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Provider Name | COURTNEY Y WASHINGTON EDD, LPC
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Gender | Female
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Dates
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Enumeration Date | 07/24/2012
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Last Update Date | 08/22/2019
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Provider Practice Location Address
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Address Line | 22456 S KANE ST
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City | DETROIT
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State | MI
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Zip | 48223-2541
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Country | US
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Telephone | 419-378-1969
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Fax |
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Provider Business Mailing Address
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Address Line | 23240 S BROOKSIDE DR
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City | DEARBORN HEIGHTS
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State | MI
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Zip | 48125-2321
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Country | US
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Telephone | 313-949-2624
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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 | 6401011384
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 6401011384
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License Number State | MI
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