Provider Demographics
NPI:1558689323
Name:BRAXTON, DARRYL EDWARD (LCPC)
Entity Type:Individual
Prefix:MR
First Name:DARRYL
Middle Name:EDWARD
Last Name:BRAXTON
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:MR
Other - First Name:DARRYL
Other - Middle Name:EDWARD
Other - Last Name:BRAXTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCPC-702
Mailing Address - Street 1:919 CALWELL RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21229-5006
Mailing Address - Country:US
Mailing Address - Phone:443-882-1943
Mailing Address - Fax:
Practice Address - Street 1:3808 EASTERN AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224-4221
Practice Address - Country:US
Practice Address - Phone:443-882-1943
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-04
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLCA1542101YP2500X
MDLC7034101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional