Provider Demographics
NPI:1922662147
Name:GRAHAM, ROCHELLE R (MA, LAC)
Entity Type:Individual
Prefix:MRS
First Name:ROCHELLE
Middle Name:R
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:MA, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 LATIMER WAY
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08016-2930
Mailing Address - Country:US
Mailing Address - Phone:314-605-0829
Mailing Address - Fax:
Practice Address - Street 1:1 LATIMER WAY
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08016-0801
Practice Address - Country:US
Practice Address - Phone:314-605-0829
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-23
Last Update Date:2019-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00365700101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional