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General NPI Number Information
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NPI Number | 1437140092
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Entity Type | Individual
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Provider Name | MARK WSEVOLOD ISAJIW L.C.S.W.
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Gender | Male
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Dates
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Enumeration Date | 11/02/2005
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Last Update Date | 07/13/2026
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Provider Practice Location Address
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Address Line | UNIT 6180, BOX 245
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City | APO
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State | AE
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Zip | 09604-0245
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Country | IT
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Telephone | 43-430-5321
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Fax | 43-430-5668
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Provider Business Mailing Address
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Address Line | PSC 53, BOX 1861
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City | APO
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State | AE
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Zip | 09601
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Country | IT
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Telephone | 43-430-5321
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Fax | 04345668
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LW00004144
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License Number State | WA
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