Provider Demographics
NPI:1043519903
Name:GRAHAM, ALL'WYN DALE (NCC LPC SAP ADC)
Entity Type:Individual
Prefix:MR
First Name:ALL'WYN
Middle Name:DALE
Last Name:GRAHAM
Suffix:
Gender:M
Credentials:NCC LPC SAP ADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2251 HELTON DR
Mailing Address - Street 2:APT E5
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35630-1084
Mailing Address - Country:US
Mailing Address - Phone:256-348-8131
Mailing Address - Fax:
Practice Address - Street 1:4011 MERIDIAN ST
Practice Address - Street 2:
Practice Address - City:NORMAL
Practice Address - State:AL
Practice Address - Zip Code:35762-5312
Practice Address - Country:US
Practice Address - Phone:256-372-4751
Practice Address - Fax:256-372-5599
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-17
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL20238101YA0400X
AL524101YA0400X
AL2942101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL2942OtherLPC
20238OtherSAP