Provider Demographics
NPI:1891970638
Name:GRAHAM, MARLENE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MARLENE
Middle Name:
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 20008
Mailing Address - Street 2:THE GROTTO COUNSELING CENTER
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97294
Mailing Address - Country:US
Mailing Address - Phone:503-261-2425
Mailing Address - Fax:503-254-7948
Practice Address - Street 1:8840 NE SKIDMORE STREET
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97220
Practice Address - Country:US
Practice Address - Phone:503-261-2425
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-28
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor