Healthcare Provider Details

I. General information

NPI: 1215172366
Provider Name (Legal Business Name): JOSEPH GRAHAM LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2008
Last Update Date: 06/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 HIGHTWAY 64 EAST
AUGUSTA AR
72006-5150
US

IV. Provider business mailing address

117 S 2ND ST PO BOX 497
AUGUSTA AR
72006-2309
US

V. Phone/Fax

Practice location:
  • Phone: 870-347-3352
  • Fax: 870-347-5556
Mailing address:
  • Phone: 870-347-2534
  • Fax: 870-347-3492

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2155-C
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: