Provider Demographics
NPI:1598809469
Name:GRAHAM, LATRINA (LPC)
Entity Type:Individual
Prefix:MRS
First Name:LATRINA
Middle Name:
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 1:2890 HIGHWAY 212 SW
Mailing Address - Street 2:STE A-289
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30094-3363
Mailing Address - Country:US
Mailing Address - Phone:404-550-3225
Mailing Address - Fax:404-855-2887
Practice Address - Street 1:821 PAVILION CT
Practice Address - Street 2:STE A
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-5222
Practice Address - Country:US
Practice Address - Phone:404-550-3225
Practice Address - Fax:404-855-2887
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC006099101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional