MEDICARE: MS. VIRGINIA L GRAHAM LPC

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	101YP2500X	Professional Counselor	0701005474	VA
2	101YP2500X	Professional Counselor	PRC14186	DC

General Provider Information

NPI Number	:	1649618992
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. VIRGINIA L GRAHAM LPC

Provider Business Mailing Address
First Line	:	3109 OLIN DR
Second Line	:
City	:	FALLS CHURCH
State	:	VA
Zip	:	22044-2621
Country	:	US
Telephone Number	:	703-989-7386
Fax Number	:

Provider Business Practice Location Address
First Line	:	3109 OLIN DR
Second Line	:
City	:	FALLS CHURCH
State	:	VA
Zip	:	22044-2621
Country	:	US
Telephone Number	:	703-989-7386
Fax Number	:

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

Provider Enumeration Date	:	06/10/2013
Last Update Date	:	06/10/2013

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