Healthcare Provider Details

I. General information

NPI: 1811802903
Provider Name (Legal Business Name): ALEXIS GRAHAM
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

153 ROBINS REST RD
BLUEFIELD WV
24701-4791
US

IV. Provider business mailing address

153 ROBINS REST RD
BLUEFIELD WV
24701-4791
US

V. Phone/Fax

Practice location:
  • Phone: 304-809-8042
  • Fax:
Mailing address:
  • Phone:
  • Fax: 304-809-8042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: