Provider Demographics
NPI:1306045604
Name:ISHAQ, MAGGIE C (MS, LMHC, SUDP, CCS)
Entity Type:Individual
Prefix:
First Name:MAGGIE
Middle Name:C
Last Name:ISHAQ
Suffix:
Gender:F
Credentials:MS, LMHC, SUDP, CCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7500 212TH ST SW STE 205
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-7617
Mailing Address - Country:US
Mailing Address - Phone:425-977-4988
Mailing Address - Fax:425-977-4989
Practice Address - Street 1:7500 212TH ST SW STE 205
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-7617
Practice Address - Country:US
Practice Address - Phone:425-977-4988
Practice Address - Fax:425-977-4989
Is Sole Proprietor?:No
Enumeration Date:2007-07-16
Last Update Date:2024-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP00005296101YA0400X
WALH60200522101YM0800X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2150671Medicaid
WA2150670Medicaid