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General NPI Number Information
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NPI Number | 1538303896
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Entity Type | Individual
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Provider Name | SERINE M GRAHAM LPC, LISAC
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Gender | Female
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Dates
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Enumeration Date | 04/29/2009
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Last Update Date | 04/29/2009
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Provider Practice Location Address
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Address Line | 7418 E HELM DR SUITE 116
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City | SCOTTSDALE
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State | AZ
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Zip | 85260-2418
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Country | US
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Telephone | 602-376-5002
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Fax | 602-926-8892
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Provider Business Mailing Address
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Address Line | 7418 E HELM DR SUITE 116
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City | SCOTTSDALE
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State | AZ
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Zip | 85260-2418
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Country | US
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Telephone | 602-376-5002
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Fax | 602-926-8892
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | LISAC 10535
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC11571
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License Number State | AZ
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