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General NPI Number Information
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NPI Number | 1649501875
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Entity Type | Individual
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Provider Name | ANNIE DUNFORD ISAAC MHR, LBSW-IPR, LCDC
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Gender | Female
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Dates
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Enumeration Date | 01/28/2010
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Last Update Date | 09/16/2010
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Provider Practice Location Address
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Address Line | 1423 W PARKWOOD AVE APT. 2104
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City | FRIENDSWOOD
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State | TX
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Zip | 77546-5707
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Country | US
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Telephone | 281-513-3859
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Fax |
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Provider Business Mailing Address
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Address Line | 2245 N MAIN ST SUITE 2
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City | PEARLAND
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State | TX
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Zip | 77581-4144
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Country | US
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Telephone | 281-513-3859
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Fax | 281-741-3363
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 7259
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 26919
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | MASTER OF HUMAN RELA
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License Number State | OK
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