MEDICARE: DAMARA JOI KIPPINS-GRAHAM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor

General Provider Information

NPI Number	:	1295378602
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAMARA JOI KIPPINS-GRAHAM

Provider Business Mailing Address
First Line	:	107 CARPENTER DR STE 110
Second Line	:
City	:	STERLING
State	:	VA
Zip	:	20164-4468
Country	:	US
Telephone Number	:	703-297-4368
Fax Number	:

Provider Business Practice Location Address
First Line	:	107 CARPENTER DR STE 110
Second Line	:
City	:	STERLING
State	:	VA
Zip	:	20164-4468
Country	:	US
Telephone Number	:	703-297-4368
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/18/2019
Last Update Date	:	10/18/2019

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Directions to “ DAMARA JOI KIPPINS-GRAHAM ” Practice Location

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