Provider Demographics
NPI:1578692810
Name:GRAHAM, JANICE L (CDP, MA)
Entity Type:Individual
Prefix:MS
First Name:JANICE
Middle Name:L
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:CDP, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15150 140TH WAY SE
Mailing Address - Street 2:K101
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98058-7834
Mailing Address - Country:US
Mailing Address - Phone:425-351-1867
Mailing Address - Fax:
Practice Address - Street 1:10940 NE 33RD PL
Practice Address - Street 2:SUITE 107
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-1432
Practice Address - Country:US
Practice Address - Phone:425-351-1867
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)