Healthcare Provider Details

I. General information

NPI: 1548836018
Provider Name (Legal Business Name): BRIANNA GRAHAM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2021
Last Update Date: 06/03/2021
Certification Date: 06/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2639 CONNECTICUT AVE NW STE 251
WASHINGTON DC
20008-2651
US

IV. Provider business mailing address

4516 5TH ST NW
WASHINGTON DC
20011-4714
US

V. Phone/Fax

Practice location:
  • Phone: 240-722-1014
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: