Provider Demographics
NPI:1306113485
Name:WONG, ISADORA AREVALO (MA, LMHC)
Entity type:Individual
Prefix:
First Name:ISADORA
Middle Name:AREVALO
Last Name:WONG
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:823 NE 65TH ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-5539
Mailing Address - Country:US
Mailing Address - Phone:206-300-3226
Mailing Address - Fax:206-729-6313
Practice Address - Street 1:823 NE 65TH ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-5539
Practice Address - Country:US
Practice Address - Phone:206-300-3226
Practice Address - Fax:206-729-6313
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-17
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH 00005694101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health