Healthcare Provider Details

I. General information

NPI: 1114564184
Provider Name (Legal Business Name): HELENA GRAHAM LPCC, LICDC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2019
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 S EDWIN C MOSES BLVD
DAYTON OH
45417-3424
US

IV. Provider business mailing address

5118 POCONO DR
DAYTON OH
45424-6017
US

V. Phone/Fax

Practice location:
  • Phone: 937-741-8333
  • Fax:
Mailing address:
  • Phone: 937-626-4807
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberE.2505487
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLICDC.162585
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: