Deirdre Nedene Isom, EDD
Individual provider Active NPI Mental Health Counselor · Archdale, NC
NPI 1124867353 · NPPES record last updated May 20, 2024
Key facts
- NPI
- 1124867353
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Mental Health Counselor 101YM0800X
- License
- A20012 (NC)
- Practice address
- 1016 Sagewood LN
Archdale, NC 27263-2973 - Phone
- (336) 541-6236
- NPI assigned
- May 20, 2024
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A20012 | NC | MD | Mental Health Counselor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | A20012 | NC | Yes |
Addresses
Primary practice location
1016 Sagewood LN
Archdale, NC 27263-2973
Mailing address
1016 Sagewood LN
Archdale, NC 27263-2973
Phone (336) 541-6236
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- Ryan Thomas Hoskins
- N'Tuma Monday Jah
- John D. Ellington DDS PA
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- Chris Jones
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All providers in Archdale, NC · Mental Health Counselor in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 20, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.