MEDICARE: BRAXTON DUBOIS DUBIN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	LGP16872	MD

General Provider Information

NPI Number	:	1215879325
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRAXTON DUBOIS DUBIN

Provider Business Mailing Address
First Line	:	7400 TRAVERTINE DR UNIT 307
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21209-5281
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7400 TRAVERTINE DR UNIT 307
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21209-5281
Country	:	US
Telephone Number	:	443-461-4594
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/07/2026
Last Update Date	:	04/07/2026

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Directions to “ BRAXTON DUBOIS DUBIN ” Practice Location

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