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General NPI Number Information
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NPI Number | 1114239134
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Entity Type | Organization
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Legal Business Name | ISAIAH COUNSELING & WELLNESS PLLC
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Dates
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Enumeration Date | 07/07/2010
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Last Update Date | 08/06/2022
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Provider Practice Location Address
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Address Line | 1914 BRUNSWICK AVE SUITE 1B
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City | CHARLOTTE
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State | NC
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Zip | 28207-2808
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Country | US
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Telephone | 704-910-2055
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 29158
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City | CHARLOTTE
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State | NC
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Zip | 28229-9158
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Country | US
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Telephone | 704-965-2364
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SHAWNTAL M ISAIAH
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Credential | LCSW
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Telephone | 704-965-2364
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | C005180
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License Number State | NC
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