Provider Demographics
NPI:1538303896
Name:GRAHAM, SERINE M (LPC, LISAC)
Entity Type:Individual
Prefix:
First Name:SERINE
Middle Name:M
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:LPC, LISAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7418 E HELM DR
Mailing Address - Street 2:SUITE 116
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-2418
Mailing Address - Country:US
Mailing Address - Phone:602-376-5002
Mailing Address - Fax:602-926-8892
Practice Address - Street 1:7418 E HELM DR
Practice Address - Street 2:SUITE 116
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-2418
Practice Address - Country:US
Practice Address - Phone:602-376-5002
Practice Address - Fax:602-926-8892
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-29
Last Update Date:2009-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLISAC 10535101YA0400X
AZLPC11571101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)