Provider Demographics
NPI:1841226958
Name:GRAHAM, LINDA LEWIS (LPC/MHSP)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:LEWIS
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:LPC/MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37408-1425
Mailing Address - Country:US
Mailing Address - Phone:423-402-0246
Mailing Address - Fax:423-815-9017
Practice Address - Street 1:625 E MAIN ST
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37408-1425
Practice Address - Country:US
Practice Address - Phone:423-402-0246
Practice Address - Fax:423-815-9017
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-23
Last Update Date:2016-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1733101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN803856Medicaid