Provider Demographics
NPI:1700320884
Name:ISOM, ANGELA (COUNSELING LICENSE)
Entity Type:Individual
Prefix:PROF
First Name:ANGELA
Middle Name:
Last Name:ISOM
Suffix:
Gender:M
Credentials:COUNSELING LICENSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17419 WAYNE DR
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44128-3372
Mailing Address - Country:US
Mailing Address - Phone:216-592-8521
Mailing Address - Fax:
Practice Address - Street 1:2000 LEE RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44118-2572
Practice Address - Country:US
Practice Address - Phone:216-592-8521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-08
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1200588101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health