Individual
MALCOLM L BROADNAX
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4412 COLE FARM RD, NOTTINGHAM, MD 21236-2961
(443) 528-0822
Mailing address
2710 PELHAM AVE, BALTIMORE, MD 21213-1119
(443) 528-0822
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
LCA3486
MD
101YM0800X
Mental Health Counselor
LGP14898
MD
Other
Enumeration date
06/11/2024
Last updated
06/11/2025
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