Provider Demographics
NPI:1265021729
Name:GRAHAM, SHACOYA J (MA, LMFT-A, LCAS-A)
Entity Type:Individual
Prefix:
First Name:SHACOYA
Middle Name:J
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:MA, LMFT-A, LCAS-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2515 ANNA GARRISON RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28206-1767
Mailing Address - Country:US
Mailing Address - Phone:843-465-2486
Mailing Address - Fax:
Practice Address - Street 1:2515 ANNA GARRISON RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28206-1767
Practice Address - Country:US
Practice Address - Phone:843-465-2486
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-11
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-26532101YA0400X
NC12259A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)