Provider Demographics
NPI:1790706729
Name:GRAHAM, ANDREW JAMES (LPC)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:JAMES
Last Name:GRAHAM
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:111 BERKSHIRE PL
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24502-2138
Mailing Address - Country:US
Mailing Address - Phone:434-237-0270
Mailing Address - Fax:
Practice Address - Street 1:2215 LANGHORNE RD
Practice Address - Street 2:SUITE 102-B
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24501-1121
Practice Address - Country:US
Practice Address - Phone:434-948-4831
Practice Address - Fax:434-948-4855
Is Sole Proprietor?:No
Enumeration Date:2006-07-23
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4639101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health