| Issiaih House 1 | |
|
2301 Dorsey Rd Glen Burnie MD 21061-3299 | |
| (443) 882-1943 | |
| Not Available |
| Full Name | Issiaih House 1 |
|---|---|
| Speciality | Clinic/center |
| Location | 2301 Dorsey Rd, Glen Burnie, Maryland |
| Authorized Official Name and Position | Darryl Braxton (OWNER) |
| Authorized Official Contact | 4438821943 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Issiaih House 1 4313 Briggs Chaney Rd Beltsville MD 20705-1044 Ph: (443) 882-1943 | Issiaih House 1 2301 Dorsey Rd Glen Burnie MD 21061-3299 Ph: (443) 882-1943 |
| NPI Number | 1568096428 |
|---|---|
| Provider Enumeration Date | 02/28/2020 |
| Last Update Date | 02/28/2020 |
| Certification Date | 02/28/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568096428 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | (* (Not Available)) | Secondary |
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
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