Provider Demographics
NPI:1306213855
Name:GRAHAM, SHEILA (CAC-AD)
Entity Type:Individual
Prefix:
First Name:SHEILA
Middle Name:
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:CAC-AD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4659 LOGSDON DR
Mailing Address - Street 2:
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-3564
Mailing Address - Country:US
Mailing Address - Phone:301-773-3500
Mailing Address - Fax:301-773-1170
Practice Address - Street 1:4659 LOGSDON DR
Practice Address - Street 2:
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-3564
Practice Address - Country:US
Practice Address - Phone:301-773-3500
Practice Address - Fax:301-773-1170
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-31
Last Update Date:2015-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAC1794101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)