Provider Demographics
NPI:1467195388
Name:GRAHAM, SANDRA G (LPC)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:G
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 1:231 ALLIE KAT WAY
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37042-1975
Mailing Address - Country:US
Mailing Address - Phone:931-220-7844
Mailing Address - Fax:931-494-8250
Practice Address - Street 1:231 ALLIE KAT WAY
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37042-1975
Practice Address - Country:US
Practice Address - Phone:931-220-7844
Practice Address - Fax:931-494-8250
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-18
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000004899101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health