Provider Demographics
NPI:1134206584
Name:GRAHAM, RENEE DEE (LCSW)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:DEE
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:RENEE
Other - Middle Name:HALPERN
Other - Last Name:GRAHAM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:3937 WESTERN BLVD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27606-1936
Mailing Address - Country:US
Mailing Address - Phone:919-821-0790
Mailing Address - Fax:919-518-9476
Practice Address - Street 1:3937 WESTERN BLVD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27606-1936
Practice Address - Country:US
Practice Address - Phone:919-821-0790
Practice Address - Fax:919-861-8961
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0027911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6003334Medicaid
NC36529OtherBCBS PROVIDER NUMBER
NC2877408Medicare PIN