Provider Demographics
NPI:1518149798
Name:BRAXTON, ANDREA C (MED, NCC, LPC)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:C
Last Name:BRAXTON
Suffix:
Gender:F
Credentials:MED, NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1106 KNORR ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19111-4930
Mailing Address - Country:US
Mailing Address - Phone:215-796-5418
Mailing Address - Fax:
Practice Address - Street 1:1106 KNORR ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19111-4930
Practice Address - Country:US
Practice Address - Phone:215-796-5418
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-29
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00367400101YP2500X
VA0701009114101YP2500X
PAPC003852101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional