Provider Demographics
NPI:1558953141
Name:GRAHAM, NANCY TERESA (LCSW-C)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:TERESA
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11200 KINSALE CT
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-6132
Mailing Address - Country:US
Mailing Address - Phone:202-270-2481
Mailing Address - Fax:
Practice Address - Street 1:11200 KINSALE CT
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-6132
Practice Address - Country:US
Practice Address - Phone:202-270-2481
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-05
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD092141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty