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General NPI Number Information
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NPI Number | 1902305220
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Entity Type | Individual
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Provider Name | SHIRLEY CONTRINE WASHINGTON
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Gender | Female
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Dates
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Enumeration Date | 02/02/2018
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Last Update Date | 02/02/2018
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Provider Practice Location Address
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Address Line | 700 S CLINTON ST
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City | CHICAGO
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State | IL
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Zip | 60607-4350
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Country | US
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Telephone | 312-927-1556
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Fax | 312-274-5576
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Provider Business Mailing Address
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Address Line | 3243 187TH ST APT 304
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City | LANSING
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State | IL
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Zip | 60438-3561
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Country | US
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Telephone | 708-288-8513
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 178.012025
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License Number State | IL
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