Provider Demographics
NPI:1073106035
Name:ISAAC, ALEXIS JEANNETTE (MA, NCC)
Entity type:Individual
Prefix:MISS
First Name:ALEXIS
Middle Name:JEANNETTE
Last Name:ISAAC
Suffix:
Gender:F
Credentials:MA, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:419 RUTHERFORD AVE NE
Mailing Address - Street 2:PO BOX #12204
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24022
Mailing Address - Country:US
Mailing Address - Phone:540-315-8333
Mailing Address - Fax:
Practice Address - Street 1:419 RUTHERFORD AVE NE
Practice Address - Street 2:PO BOX #12204
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24022
Practice Address - Country:US
Practice Address - Phone:540-315-8333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-19
Last Update Date:2025-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0704016097101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional