Provider Demographics
NPI:1164858239
Name:GRAHAM, CECILIA ANN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:CECILIA
Middle Name:ANN
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:271 FT. RICHARDSON AVE BLDG 1007
Mailing Address - Street 2:
Mailing Address - City:GOODFELLOW AFB
Mailing Address - State:TX
Mailing Address - Zip Code:76908
Mailing Address - Country:US
Mailing Address - Phone:325-654-3122
Mailing Address - Fax:325-654-5161
Practice Address - Street 1:271 FT. RICHARDSON AVE BLDG 1007
Practice Address - Street 2:
Practice Address - City:GOODFELLOW AFB
Practice Address - State:TX
Practice Address - Zip Code:76908
Practice Address - Country:US
Practice Address - Phone:325-654-3122
Practice Address - Fax:325-654-5161
Is Sole Proprietor?:No
Enumeration Date:2013-09-20
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1065811041C0700X
AZLCSW-125721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical