Provider Demographics
NPI:1417691106
Name:GRAHAM, KEYANA A (LGPC)
Entity Type:Individual
Prefix:
First Name:KEYANA
Middle Name:A
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7604 HEARTHSIDE WAY UNIT 1039
Mailing Address - Street 2:
Mailing Address - City:ELKRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21075-7365
Mailing Address - Country:US
Mailing Address - Phone:301-806-0138
Mailing Address - Fax:
Practice Address - Street 1:11785 BELTSVILLE DR STE 120
Practice Address - Street 2:
Practice Address - City:BELTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20705-3121
Practice Address - Country:US
Practice Address - Phone:240-389-1487
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-27
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP12640101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health