Healthcare Provider Details

I. General information

NPI: 1366223620
Provider Name (Legal Business Name): JAMES NATHANIEL GRAHAM LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2023
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1512 KESTWICK DR
HOOVER AL
35226-2277
US

IV. Provider business mailing address

1512 KESTWICK DR
HOOVER AL
35226-2277
US

V. Phone/Fax

Practice location:
  • Phone: 334-452-0316
  • Fax:
Mailing address:
  • Phone: 334-452-0316
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number8081111
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberTPMC7760
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number068.0137202TELE
License Number StateVT
# 4
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberALC04620
License Number StateAL
# 5
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC05899
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: