Provider Demographics
NPI:1437342110
Name:GRAHAM, STEPHANYE (LCMHCA)
Entity Type:Individual
Prefix:
First Name:STEPHANYE
Middle Name:
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1129 VESPER LN
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28311-2433
Mailing Address - Country:US
Mailing Address - Phone:910-366-0754
Mailing Address - Fax:
Practice Address - Street 1:1129 VESPER LN
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28311-2433
Practice Address - Country:US
Practice Address - Phone:910-366-0754
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-25
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR008232111N00000X
NC4038111N00000X
NCA16260101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No111N00000XChiropractic ProvidersChiropractor