Provider Demographics
NPI:1699123646
Name:WEBSTER, DARRYL BRYANT
Entity type:Individual
Prefix:MR
First Name:DARRYL
Middle Name:BRYANT
Last Name:WEBSTER
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 1:6665 SECURITY BLVD
Mailing Address - Street 2:
Mailing Address - City:WOODLAWN
Mailing Address - State:MD
Mailing Address - Zip Code:21207-4018
Mailing Address - Country:US
Mailing Address - Phone:410-265-7291
Mailing Address - Fax:410-265-7294
Practice Address - Street 1:6665 SECURITY BLVD
Practice Address - Street 2:
Practice Address - City:WOODLAWN
Practice Address - State:MD
Practice Address - Zip Code:21207-4018
Practice Address - Country:US
Practice Address - Phone:410-265-7291
Practice Address - Fax:410-265-7294
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-01
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC6442101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional