Organization
ISSAIAH HOUSE INC
Active
Parent organization
ISSAIAH HOUSE INC
Organization subpart
Yes
Provider details
NPI number
Legal business name
ISSAIAH HOUSE INC
Authorized official
MR. DARRYL EDWARD BRAXTON LCPC, LCADC (OWNER)
(443) 882-1943
Entity
Organization
Contact information
Practice address
3808 EASTERN AVE, BALTIMORE, MD 21224-4221
(443) 882-1943
Mailing address
919 CALWELL RD, BALTIMORE, MD 21229-5006
(144) 388-2194
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
250016700
—
MD
Enumeration date
09/13/2018
Last updated
05/18/2021
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