Provider Demographics
NPI:1134356116
Name:GRAHAM, KENT L (MA, LPC, LCAS, CCS)
Entity type:Individual
Prefix:
First Name:KENT
Middle Name:L
Last Name:GRAHAM
Suffix:
Gender:M
Credentials:MA, LPC, LCAS, CCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 IVERSON LANE
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28562
Mailing Address - Country:US
Mailing Address - Phone:910-330-6620
Mailing Address - Fax:
Practice Address - Street 1:2000 NEUSE BLVD
Practice Address - Street 2:CROSSROADS, CAROLINAEAST MEDICAL CENTER
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28560
Practice Address - Country:US
Practice Address - Phone:252-633-8215
Practice Address - Fax:252-633-8198
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-17
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC743101YA0400X
NC4420101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional