Provider Demographics
NPI:1407069644
Name:ISAIAH, RAVI J (DMIN)
Entity Type:Individual
Prefix:MR
First Name:RAVI
Middle Name:J
Last Name:ISAIAH
Suffix:
Gender:M
Credentials:DMIN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 WASHINGTON ST E
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25301-1766
Mailing Address - Country:US
Mailing Address - Phone:304-388-4290
Mailing Address - Fax:
Practice Address - Street 1:8 PINNACLE PL
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25311-1355
Practice Address - Country:US
Practice Address - Phone:304-388-4290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1290101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral