Provider Demographics
NPI:1659516060
Name:GRAHAM, DARLENE YVETTE (MA)
Entity Type:Individual
Prefix:
First Name:DARLENE
Middle Name:YVETTE
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9292 N MERIDIAN ST STE 311
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-1828
Mailing Address - Country:US
Mailing Address - Phone:317-956-9413
Mailing Address - Fax:
Practice Address - Street 1:9292 N MERIDIAN ST STE 311
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-1828
Practice Address - Country:US
Practice Address - Phone:317-956-9413
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-15
Last Update Date:2009-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health