Organization
ISSAIAH HOUSE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DARRYL BRAXTON LCPC (OWNER)
(443) 882-1943
Entity
Organization
Contact information
Practice address
2802 HARFORD RD, BALTIMORE, MD 21218-4953
(443) 882-1943
Mailing address
4331 PARKTON ST, BALTIMORE, MD 21229-4521
(443) 882-1943
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
LC7034
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
250016700
—
MD
Enumeration date
07/13/2017
Last updated
12/10/2020
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