Provider Demographics
NPI:1205011269
Name:GRAHAM, DEANNA (MA, BSW, QP)
Entity Type:Individual
Prefix:MRS
First Name:DEANNA
Middle Name:
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:MA, BSW, QP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:745C HWY. 117S
Mailing Address - Street 2:
Mailing Address - City:BURGAW
Mailing Address - State:NC
Mailing Address - Zip Code:28425
Mailing Address - Country:US
Mailing Address - Phone:910-259-0239
Mailing Address - Fax:910-259-0239
Practice Address - Street 1:745-C HIGHWAY 117S
Practice Address - Street 2:
Practice Address - City:BURGAW
Practice Address - State:NC
Practice Address - Zip Code:28425
Practice Address - Country:US
Practice Address - Phone:910-259-0239
Practice Address - Fax:910-259-0239
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-08
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management