Provider Demographics
NPI:1336318104
Name:GRAHAM, LAURA ANDERSON (LPC)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:ANDERSON
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:ROSE
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3855 SHALLOWFORD RD
Mailing Address - Street 2:SUITE 420
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-4195
Mailing Address - Country:US
Mailing Address - Phone:770-592-0566
Mailing Address - Fax:
Practice Address - Street 1:3855 SHALLOWFORD RD
Practice Address - Street 2:SUITE 420
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-4195
Practice Address - Country:US
Practice Address - Phone:770-592-0566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-26
Last Update Date:2009-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC003312101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health