Provider Demographics
NPI:1205329927
Name:GRAHAM, ARVELLA JINNETTE (LPCA)
Entity type:Individual
Prefix:
First Name:ARVELLA
Middle Name:JINNETTE
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 W EAGLE PASS RD
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-8520
Mailing Address - Country:US
Mailing Address - Phone:314-603-3290
Mailing Address - Fax:
Practice Address - Street 1:725 NEW GLENDALE RD
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-8373
Practice Address - Country:US
Practice Address - Phone:270-900-0327
Practice Address - Fax:270-900-0426
Is Sole Proprietor?:No
Enumeration Date:2018-06-07
Last Update Date:2018-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY241549101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional