Individual
ANDRE WASHINGTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
20 MYSTIC CT, DALZELL, SC 29040-8382
(803) 236-6233
Mailing address
20 MYSTIC CT, DALZELL, SC 29040-8382
(803) 236-6233
Taxonomy
Speciality
Code
Description
License number
State
374U00000X
Home Health Aide
Primary
218782
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
218782
BUSINESS LICENSE
SC
Enumeration date
12/02/2020
Last updated
12/02/2020
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