Provider Demographics
NPI:1548540545
Name:WASHINGTON, VANESSA LYNN (LPC)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:LYNN
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:VANESSA
Other - Middle Name:LYNN
Other - Last Name:MARKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:511 SW 10TH AVE STE 1104
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-2712
Mailing Address - Country:US
Mailing Address - Phone:503-444-8214
Mailing Address - Fax:888-978-8164
Practice Address - Street 1:511 SW 10TH AVE STE 1104
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-2712
Practice Address - Country:US
Practice Address - Phone:503-444-8214
Practice Address - Fax:888-978-8164
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-22
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC3358101YP2500X
101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500669881Medicaid