Provider Demographics
NPI:1053644146
Name:GRAHAM, LORI KRISTINE (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:KRISTINE
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20400 COLONEL GLENN RD
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72210-5323
Mailing Address - Country:US
Mailing Address - Phone:501-821-5500
Mailing Address - Fax:
Practice Address - Street 1:2 INNWOOD CIR
Practice Address - Street 2:SUITE A
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-2447
Practice Address - Country:US
Practice Address - Phone:501-954-7470
Practice Address - Fax:501-954-7420
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-08
Last Update Date:2009-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2348M104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker