Healthcare Provider Details

I. General information

NPI: 1710830823
Provider Name (Legal Business Name): FISHER STEWART ILIJASIC LGPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2026
Last Update Date: 02/18/2026
Certification Date: 02/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 MASSACHUSETTS AVE NW APT 813
WASHINGTON DC
20036-2116
US

IV. Provider business mailing address

1701 MASSACHUSETTS AVE NW APT 813
WASHINGTON DC
20036-2116
US

V. Phone/Fax

Practice location:
  • Phone: 216-299-8030
  • Fax:
Mailing address:
  • Phone: 216-299-8030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLGPC200012606
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: