Healthcare Provider Details

I. General information

NPI: 1528445475
Provider Name (Legal Business Name): ALLYSON GRAHAM B.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALLISON MEGAN GRAHAM B.A.

II. Dates (important events)

Enumeration Date: 04/29/2015
Last Update Date: 10/05/2021
Certification Date: 10/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3724 S GALVEZ ST
NEW ORLEANS LA
70125
US

IV. Provider business mailing address

1358 NORWALK ST APT M
GREENSBORO NC
27407-1935
US

V. Phone/Fax

Practice location:
  • Phone: 404-704-7348
  • Fax:
Mailing address:
  • Phone: 404-704-7348
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberA15996
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: