Healthcare Provider Details

I. General information

NPI: 1114855848
Provider Name (Legal Business Name): DESIREE ELAINE GRAHAM LCMHCA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5821 FAIRVIEW RD STE 101
CHARLOTTE NC
28209-5601
US

IV. Provider business mailing address

10150 MALLARD CREEK RD STE 509
CHARLOTTE NC
28262-9708
US

V. Phone/Fax

Practice location:
  • Phone: 980-308-4500
  • Fax: 980-458-6037
Mailing address:
  • Phone: 980-308-4500
  • Fax: 980-458-6037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA21539
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: