Provider Demographics
NPI:1801494687
Name:BRAXTON, AHJANAE ICESS (MSW)
Entity type:Individual
Prefix:
First Name:AHJANAE
Middle Name:ICESS
Last Name:BRAXTON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 CANTERBURY RUN
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23602-5274
Mailing Address - Country:US
Mailing Address - Phone:757-880-4175
Mailing Address - Fax:
Practice Address - Street 1:2019 CUNNINGHAM DR STE 412
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-3318
Practice Address - Country:US
Practice Address - Phone:757-535-9080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-13
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker