Healthcare Provider Details

I. General information

NPI: 1598153488
Provider Name (Legal Business Name): MEGHAN REBEKAH GRAHAM LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/31/2014
Last Update Date: 07/10/2024
Certification Date: 07/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 SEVEN MILE RIDGE RD
BURNSVILLE NC
28714-8509
US

IV. Provider business mailing address

116 SEVEN MILE RIDGE RD
BURNSVILLE NC
28714-8509
US

V. Phone/Fax

Practice location:
  • Phone: 828-675-4116
  • Fax: 828-675-9312
Mailing address:
  • Phone: 828-675-4116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number11226
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC013265
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: