Provider Demographics
NPI:1639956907
Name:ISAAC, CHANDRA (MS, ADT)
Entity Type:Individual
Prefix:MS
First Name:CHANDRA
Middle Name:
Last Name:ISAAC
Suffix:
Gender:F
Credentials:MS, ADT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1605 N MILTON AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21213-2513
Mailing Address - Country:US
Mailing Address - Phone:410-371-5443
Mailing Address - Fax:
Practice Address - Street 1:4201 BELMAR AVE # 3
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21206-1900
Practice Address - Country:US
Practice Address - Phone:667-239-3195
Practice Address - Fax:667-309-5161
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-11
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDADT3254101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty