Individual
MS. KISSIE SHANTA WASHINGTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
15476 ARCHDALE ST, DETROIT, MI 48227-1506
(248) 249-3497
Mailing address
15476 ARCHDALE ST, DETROIT, MI 48227-1506
(248) 249-3497
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
MI
247200000X
Other Technician
—
MI
385HR2055X
Child Mental Illness Respite Care
—
MI
385HR2055X
Child Mental Illness Respite Care
—
OH
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
Primary
—
MI
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
—
OH
385HR2065X
Child Physical Disabilities Respite Care
—
MI
385HR2065X
Child Physical Disabilities Respite Care
—
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
821167995
—
MI
Enumeration date
05/26/2016
Last updated
12/28/2025
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