Healthcare Provider Details

I. General information

NPI: 1265887434
Provider Name (Legal Business Name): CHARM COUNSELING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2016
Last Update Date: 04/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1002 E PATAPSCO AVE
BALTIMORE MD
21225-2229
US

IV. Provider business mailing address

4331 PARKTON ST
BALTIMORE MD
21229-4521
US

V. Phone/Fax

Practice location:
  • Phone: 410-355-3711
  • Fax:
Mailing address:
  • Phone: 443-882-1943
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberLC7034
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License NumberLC7034
License Number StateMD

VIII. Authorized Official

Name: MR. DARRYL EDWARD BRAXTON
Title or Position: LICENCE PROFESSIONAL COUNSELOR
Credential: LCPC
Phone: 443-882-1943