Healthcare Provider Details

I. General information

NPI: 1710809330
Provider Name (Legal Business Name): DANIELLE GRAHAM LCSW LCADC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

702 E MAIN ST STE 2B
MOORESTOWN NJ
08057-3079
US

IV. Provider business mailing address

200 WESTMONT AVE
HADDON TOWNSHIP NJ
08108-3414
US

V. Phone/Fax

Practice location:
  • Phone: 609-602-9854
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: DANIELLE GRAHAM
Title or Position: THERAPIST
Credential: LCSW LCADC
Phone: 609-602-9854