Provider Demographics
NPI:1326002361
Name:GRAHAM, LAURIE J (MA, MED, NCC, LPC)
Entity Type:Individual
Prefix:MS
First Name:LAURIE
Middle Name:J
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:MA, MED, NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 SHADY AVE
Mailing Address - Street 2:SUITE D 104
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15206-4409
Mailing Address - Country:US
Mailing Address - Phone:412-365-2001
Mailing Address - Fax:412-365-2087
Practice Address - Street 1:401 SHADY AVE
Practice Address - Street 2:SUITE D 104
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15206-4409
Practice Address - Country:US
Practice Address - Phone:412-365-2001
Practice Address - Fax:412-365-2087
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC003375101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1009891250002Medicaid