Healthcare Provider Details

I. General information

NPI: 1326972159
Provider Name (Legal Business Name): MR. ROBERT LEROY GRAHAM SR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4001 CLARKS LN APT 512
BALTIMORE MD
21215-2698
US

IV. Provider business mailing address

4001 CLARKS LN APT 512
BALTIMORE MD
21215-2698
US

V. Phone/Fax

Practice location:
  • Phone: 410-845-1650
  • Fax:
Mailing address:
  • Phone: 410-845-1650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number10275092096
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: