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NPI Code Detail

MEDICARE: EMILY GRAHAM LPCA

MEDICARE: EMILY GRAHAM LPCA
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
1101YA0400XAddiction (Substance Use Disorder) Counselor
2101YM0800XMental Health CounselorA10840NC

General Provider Information

NPI Number : 1992181721
Entity Type Code : Individual
Provider Name (Legal Business Name) : EMILY GRAHAM LPCA
Provider Business Mailing Address
First Line : 94 GRANT DR
Second Line :
City : HAMPSTEAD
State : NC
Zip : 28443-8433
Country : US
Telephone Number : 773-719-0574
Fax Number :
Provider Business Practice Location Address
First Line : 2875 WORTH DR
Second Line :
City : WILMINGTON
State : NC
Zip : 28412-6248
Country : US
Telephone Number : 910-523-5534
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/04/2015
Last Update Date : 08/04/2015

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