MEDICARE: LAUREN LUCILE QUICK-GRAHAM MSW

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	1041C0700X	Clinical Social Worker	C009574	NC

General Provider Information

NPI Number	:	1619300142
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN LUCILE QUICK-GRAHAM MSW

Provider Business Mailing Address
First Line	:	11010 LAKE GROVE BLVD STE 106
Second Line	:
City	:	MORRISVILLE
State	:	NC
Zip	:	27560-7391
Country	:	US
Telephone Number	:	919-230-4572
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 VISTA BROOKE DR
Second Line	:
City	:	MORRISVILLE
State	:	NC
Zip	:	27560-9713
Country	:	US
Telephone Number	:	919-230-4572
Fax Number	:

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

Provider Enumeration Date	:	08/20/2013
Last Update Date	:	08/02/2019

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