Provider Demographics
NPI:1952484453
Name:ISAIAH, SHAWNTAL M (LCSW)
Entity Type:Individual
Prefix:
First Name:SHAWNTAL
Middle Name:M
Last Name:ISAIAH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 29158
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28229-9158
Mailing Address - Country:US
Mailing Address - Phone:704-965-2364
Mailing Address - Fax:704-973-0752
Practice Address - Street 1:1914 BRUNSWICK AVE STE 1B
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28207-1891
Practice Address - Country:US
Practice Address - Phone:704-910-2055
Practice Address - Fax:704-973-0752
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2022-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0051801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical