Provider Demographics
NPI:1376082800
Name:GRAHAM, DEHIA (LPC)
Entity Type:Individual
Prefix:
First Name:DEHIA
Middle Name:
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 WARREN AVE
Mailing Address - Street 2:
Mailing Address - City:SWAINSBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30401-3645
Mailing Address - Country:US
Mailing Address - Phone:478-289-8147
Mailing Address - Fax:478-289-8148
Practice Address - Street 1:105 WARREN AVE
Practice Address - Street 2:
Practice Address - City:SWAINSBORO
Practice Address - State:GA
Practice Address - Zip Code:30401-3645
Practice Address - Country:US
Practice Address - Phone:478-289-8147
Practice Address - Fax:478-289-8148
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-16
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC009284101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional