Provider Information for 1265746861
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MARIE ISOM EdD, LPC
Other Names:Former Name:MARIE GOLDSBOROUGH MA, LPCSex: Female
NPI: 1265746861
Last Updated: 2016-09-06
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1265746861 | ||||||||
| Enumeration Date | 2010-08-06 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 500 WHALE AVE MYRTLE BEACH, SC 29588-5497 United States Phone: 843-685-2191 | Fax: | ||||||||
| Primary Practice Address | 1107 48TH AVE N STE 310A MYRTLE BEACH, SC 29577-5443 United States Phone: 843-580-4357 | Fax: | ||||||||
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