Provider Demographics
NPI:1386864494
Name:GRAHAM, JOHN ALLAN (MDIV, THM, LPC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:ALLAN
Last Name:GRAHAM
Suffix:
Gender:M
Credentials:MDIV, THM, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1955 CLIFF VALLEY WAY NE
Mailing Address - Street 2:SUITE 215
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30329-2476
Mailing Address - Country:US
Mailing Address - Phone:404-633-0321
Mailing Address - Fax:404-636-9889
Practice Address - Street 1:1955 CLIFF VALLEY WAY NE
Practice Address - Street 2:SUITE 215
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30329-2476
Practice Address - Country:US
Practice Address - Phone:404-633-0321
Practice Address - Fax:404-636-9889
Is Sole Proprietor?:No
Enumeration Date:2007-04-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC1241101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional