Healthcare Provider Details

I. General information

NPI: 1891781449
Provider Name (Legal Business Name): PAULETTE GRAHAM LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PAULETTE GRAHAM-MASSEY LCSW

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2908 HAWKINS DR
SEARCY AR
72143-4802
US

IV. Provider business mailing address

1815 PLEASANT GROVE ROAD
JONESBORO AR
72401
US

V. Phone/Fax

Practice location:
  • Phone: 501-203-0055
  • Fax: 501-203-0060
Mailing address:
  • Phone: 870-933-6886
  • Fax: 870-933-9395

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1454-C
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: