Provider Demographics
NPI:1548576630
Name:GRAHAM, GREGORY NEAL (LPC)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:NEAL
Last Name:GRAHAM
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:724 BETHEL CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:EVA
Mailing Address - State:AL
Mailing Address - Zip Code:35621-8310
Mailing Address - Country:US
Mailing Address - Phone:256-326-1380
Mailing Address - Fax:
Practice Address - Street 1:107 2ND AVE SE
Practice Address - Street 2:
Practice Address - City:CULLMAN
Practice Address - State:AL
Practice Address - Zip Code:35055-3511
Practice Address - Country:US
Practice Address - Phone:256-739-4910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-26
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2465101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional