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General NPI Number Information
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NPI Number | 1700297637
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Entity Type | Individual
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Provider Name | GLENN B GRAHAM LPC
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Gender | Male
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Dates
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Enumeration Date | 05/14/2014
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Last Update Date | 09/09/2023
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Provider Practice Location Address
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Address Line | 49 MAIN ST STE 34
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City | CLINTON
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State | NJ
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Zip | 08809-1313
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Country | US
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Telephone | 908-318-4111
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Fax |
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Provider Business Mailing Address
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Address Line | 18 OVERLOOK RD
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City | BLOOMSBURY
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State | NJ
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Zip | 08804-3502
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Country | US
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Telephone | 908-318-4111
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Fax |
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 37PC00370400
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License Number State | NJ
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