Provider Demographics
NPI:1366954356
Name:WASHINGTON, JAMIE LEE (LCMHC, LCAS)
Entity type:Individual
Prefix:MS
First Name:JAMIE
Middle Name:LEE
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:LCMHC, LCAS
Other - Prefix:MS
Other - First Name:JAMIE
Other - Middle Name:LEE
Other - Last Name:WASHINGTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCMHC, LCAS
Mailing Address - Street 1:11845 RETAIL DR # 1051
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-7352
Mailing Address - Country:US
Mailing Address - Phone:252-572-1816
Mailing Address - Fax:
Practice Address - Street 1:2310 S MIAMI BLVD STE 136
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27703-5799
Practice Address - Country:US
Practice Address - Phone:919-797-0549
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-30
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA13548101YP2500X
NCLCAS24086101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)