Provider Demographics
NPI:1528807195
Name:ISOM, RILEY ELIZABETH (LCSWA)
Entity type:Individual
Prefix:
First Name:RILEY
Middle Name:ELIZABETH
Last Name:ISOM
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:573 AVINGTON LN NE
Mailing Address - Street 2:
Mailing Address - City:LELAND
Mailing Address - State:NC
Mailing Address - Zip Code:28451-0677
Mailing Address - Country:US
Mailing Address - Phone:434-996-6201
Mailing Address - Fax:
Practice Address - Street 1:573 AVINGTON LN NE
Practice Address - Street 2:
Practice Address - City:LELAND
Practice Address - State:NC
Practice Address - Zip Code:28451-0677
Practice Address - Country:US
Practice Address - Phone:434-996-6201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-22
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0192811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical