Provider Demographics
NPI:1003148446
Name:GRAHAM, CARLOS DEVONE (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:DEVONE
Last Name:GRAHAM
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 COMMERCIAL DR
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-3662
Mailing Address - Country:US
Mailing Address - Phone:912-961-5800
Mailing Address - Fax:
Practice Address - Street 1:321 COMMERCIAL DR
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-3662
Practice Address - Country:US
Practice Address - Phone:912-961-5800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-10
Last Update Date:2018-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0073231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical