Healthcare Provider Details

I. General information

NPI: 1942551973
Provider Name (Legal Business Name): LAUREN MICHELLE GRAHAM MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2012
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1018 CHASE DR
JOHNSON CITY TN
37604-1402
US

IV. Provider business mailing address

142 GUNNERS WAY
JOHNSON CITY TN
37615-4415
US

V. Phone/Fax

Practice location:
  • Phone: 423-282-3379
  • Fax:
Mailing address:
  • Phone: 423-292-1970
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberTPSW6268
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number9804
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number14123
License Number StateTN
# 5
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904019213
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: