Provider Demographics
NPI:1376114579
Name:GRAHAM-MCCALL, REBECCA GLORIA
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:GLORIA
Last Name:GRAHAM-MCCALL
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:REBECCA
Other - Middle Name:GLORIA
Other - Last Name:GRAHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:REBECCA GRAHAM
Mailing Address - Street 1:9 DOGWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:CT
Mailing Address - Zip Code:06483-2438
Mailing Address - Country:US
Mailing Address - Phone:203-906-3280
Mailing Address - Fax:
Practice Address - Street 1:57 PLAINS RD STE 2B
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06461-2573
Practice Address - Country:US
Practice Address - Phone:203-794-6229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-08
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional