Provider Demographics
NPI:1043776917
Name:BRAXTON, TERRI C
Entity Type:Individual
Prefix:DR
First Name:TERRI
Middle Name:C
Last Name:BRAXTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19309 WINMEADE DR # 206
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-6507
Mailing Address - Country:US
Mailing Address - Phone:703-615-7523
Mailing Address - Fax:
Practice Address - Street 1:14519 WOODSTAR CT
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-6055
Practice Address - Country:US
Practice Address - Phone:703-615-7523
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-15
Last Update Date:2019-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040039011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical