Provider Demographics
NPI:1366263444
Name:SMOLDON, ISAAC (BA)
Entity type:Individual
Prefix:
First Name:ISAAC
Middle Name:
Last Name:SMOLDON
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MY HOUSE YOUTH DROP-IN CENTER
Mailing Address - Street 2:300 N. WILLOW STREET
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654
Mailing Address - Country:US
Mailing Address - Phone:907-947-9759
Mailing Address - Fax:
Practice Address - Street 1:MY HOUSE YOUTH DROP-IN CENTER
Practice Address - Street 2:300 N. WILLOW ST.
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654
Practice Address - Country:US
Practice Address - Phone:907-947-9759
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-21
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)