Provider Demographics
NPI:1073092920
Name:GRAHAM, AZARIA QUINEE (MS)
Entity Type:Individual
Prefix:
First Name:AZARIA
Middle Name:QUINEE
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2252 WELLINGTON HILLS WAY
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30039-4236
Mailing Address - Country:US
Mailing Address - Phone:404-831-0792
Mailing Address - Fax:
Practice Address - Street 1:2795 MAIN ST W STE 20B
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-3073
Practice Address - Country:US
Practice Address - Phone:678-344-7836
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-11
Last Update Date:2018-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor