Organization
ISSIAIH HOUSE 1
Active
Parent organization
ISSAIAH HOUSE INC
Other names
Issaiah House 1 Inc
Organization subpart
Yes
Provider details
NPI number
Legal business name
ISSAIAH HOUSE INC
Authorized official
MR. DARRYL BRAXTON LCPC, LCADC (OWNER)
(443) 882-1943
Entity
Organization
Contact information
Practice address
2301 DORSEY RD, GLEN BURNIE, MD 21061-3299
(443) 882-1943
Mailing address
4313 BRIGGS CHANEY RD, BELTSVILLE, MD 20705-1044
(443) 882-1943
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
261Q00000X
Clinic/Center
Primary
—
—
Other
Enumeration date
02/28/2020
Last updated
02/28/2020
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