Healthcare Provider Details

I. General information

NPI: 1144049826
Provider Name (Legal Business Name): TODD JAMES GRAHAM BA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2024
Last Update Date: 10/09/2024
Certification Date: 10/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 S 3RD AVE APT 2
ALPENA MI
49707-3571
US

IV. Provider business mailing address

630 WALNUT ST
ALPENA MI
49707-1832
US

V. Phone/Fax

Practice location:
  • Phone: 989-255-3510
  • Fax:
Mailing address:
  • Phone: 893-566-6489
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: