Individual
AHJANAE ICESS BRAXTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW
Contact information
Practice address
2019 CUNNINGHAM DR STE 412, HAMPTON, VA 23666-3318
(757) 535-9080
Mailing address
142 CANTERBURY RUN, NEWPORT NEWS, VA 23602-5274
(757) 880-4175
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
104100000X
Social Worker
—
—
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Enumeration date
10/13/2020
Last updated
10/13/2020
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