Provider Demographics
NPI:1073797650
Name:BRAXTON, PHYLLIS ARNELLA (LCPC)
Entity Type:Individual
Prefix:DR
First Name:PHYLLIS
Middle Name:ARNELLA
Last Name:BRAXTON
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 MORTON RD
Mailing Address - Street 2:
Mailing Address - City:FALMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:22405-1488
Mailing Address - Country:US
Mailing Address - Phone:240-423-0061
Mailing Address - Fax:703-563-9698
Practice Address - Street 1:8957 EDMONSTON RD
Practice Address - Street 2:SUITE M
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-1005
Practice Address - Country:US
Practice Address - Phone:240-667-4290
Practice Address - Fax:703-563-9698
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-19
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC-1071101YP2500X
VA0701002241101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional