Provider Demographics
NPI:1205202710
Name:MILDRED ARNOLD-GRAHAM
Entity Type:Organization
Organization Name:MILDRED ARNOLD-GRAHAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVISIONAL LCSW
Authorized Official - Prefix:MRS
Authorized Official - First Name:MILDRED
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:ARNOLD GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:PSW962
Authorized Official - Phone:937-371-6603
Mailing Address - Street 1:1034 W 13TH ST
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33805-2606
Mailing Address - Country:US
Mailing Address - Phone:937-371-6603
Mailing Address - Fax:
Practice Address - Street 1:1034 W 13TH ST
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33805-2606
Practice Address - Country:US
Practice Address - Phone:937-371-6603
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-19
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPSW9621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty