Provider Demographics
NPI:1558962902
Name:BAYLOR, DARNELL
Entity Type:Individual
Prefix:
First Name:DARNELL
Middle Name:
Last Name:BAYLOR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1721 PENNSYLVANIA AVE STE 205
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21217-3119
Mailing Address - Country:US
Mailing Address - Phone:443-869-6041
Mailing Address - Fax:
Practice Address - Street 1:1721 PENNSYLVANIA AVE STE 205
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21217-3119
Practice Address - Country:US
Practice Address - Phone:443-869-6041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-03
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDSC0652OtherLICENSE