Provider Demographics
NPI:1629199310
Name:ISBELL, WAYNE (LMSW, CAC-I)
Entity Type:Individual
Prefix:MR
First Name:WAYNE
Middle Name:
Last Name:ISBELL
Suffix:
Gender:M
Credentials:LMSW, CAC-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19172 DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:REDFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48240-2626
Mailing Address - Country:US
Mailing Address - Phone:313-543-3201
Mailing Address - Fax:313-369-1728
Practice Address - Street 1:17141 RYAN RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48212-1112
Practice Address - Country:US
Practice Address - Phone:313-369-4398
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801019664101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)