Provider Demographics
NPI:1023036738
Name:GRAHAM, AMANDA J (LPC)
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:J
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4203 BAHAMA RD
Mailing Address - Street 2:
Mailing Address - City:ROUGEMONT
Mailing Address - State:NC
Mailing Address - Zip Code:27572-8795
Mailing Address - Country:US
Mailing Address - Phone:919-810-6206
Mailing Address - Fax:
Practice Address - Street 1:3622 LYCKAN PKWY STE 4003
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-2566
Practice Address - Country:US
Practice Address - Phone:970-410-1570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2019-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3811101YP2500X
CO3272101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional