Provider Demographics
NPI:1902305220
Name:WASHINGTON, SHIRLEY CONTRINE
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:CONTRINE
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3243 187TH ST APT 304
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:IL
Mailing Address - Zip Code:60438-3561
Mailing Address - Country:US
Mailing Address - Phone:708-288-8513
Mailing Address - Fax:
Practice Address - Street 1:700 S CLINTON ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-4350
Practice Address - Country:US
Practice Address - Phone:312-927-1556
Practice Address - Fax:312-274-5576
Is Sole Proprietor?:No
Enumeration Date:2018-02-02
Last Update Date:2018-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.012025101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional