Healthcare Provider Details

I. General information

NPI: 1659236826
Provider Name (Legal Business Name): STOIC NOMAD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1572 HIGHWAY 20 E
COLVILLE WA
99114-9028
US

IV. Provider business mailing address

1572 HIGHWAY 20 E
COLVILLE WA
99114-9028
US

V. Phone/Fax

Practice location:
  • Phone: 509-496-1915
  • Fax:
Mailing address:
  • Phone: 509-496-1915
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: RONALD E GRAHAM
Title or Position: CLINICIAN
Credential: LICSW
Phone: 509-496-1915