Provider Demographics
NPI:1477988368
Name:GRAHAM, ROCHELLE SIMONE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:ROCHELLE
Middle Name:SIMONE
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:PO BOX 2898
Mailing Address - Street 2:
Mailing Address - City:HARTSVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29551-2898
Mailing Address - Country:US
Mailing Address - Phone:843-992-6014
Mailing Address - Fax:
Practice Address - Street 1:144 MARLBORO AVE
Practice Address - Street 2:
Practice Address - City:HARTSVILLE
Practice Address - State:SC
Practice Address - Zip Code:29550-4218
Practice Address - Country:US
Practice Address - Phone:843-992-6014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-10
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5579101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional