Provider Demographics
NPI:1285218297
Name:GRAHAM, NANCY (LMHC)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:227 KAREN CT
Mailing Address - Street 2:
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32578-2613
Mailing Address - Country:US
Mailing Address - Phone:185-059-8313
Mailing Address - Fax:
Practice Address - Street 1:227 KAREN CT
Practice Address - Street 2:
Practice Address - City:NICEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32578-2613
Practice Address - Country:US
Practice Address - Phone:850-696-6381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-06
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL19156101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health