Provider Demographics
NPI:1649501875
Name:ISAAC, ANNIE DUNFORD (MHR, LBSW-IPR, LCDC)
Entity type:Individual
Prefix:MS
First Name:ANNIE
Middle Name:DUNFORD
Last Name:ISAAC
Suffix:
Gender:F
Credentials:MHR, LBSW-IPR, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2245 N MAIN ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77581-4144
Mailing Address - Country:US
Mailing Address - Phone:281-513-3859
Mailing Address - Fax:281-741-3363
Practice Address - Street 1:1423 W PARKWOOD AVE
Practice Address - Street 2:APT. 2104
Practice Address - City:FRIENDSWOOD
Practice Address - State:TX
Practice Address - Zip Code:77546-5707
Practice Address - Country:US
Practice Address - Phone:281-513-3859
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-28
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7259101YA0400X
TX26919104100000X
OKMASTER OF HUMAN RELA103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling