Provider Demographics
NPI:1255619474
Name:NOLE-GRAHAM, ROXANN (MS NCC LPC)
Entity type:Individual
Prefix:MRS
First Name:ROXANN
Middle Name:
Last Name:NOLE-GRAHAM
Suffix:
Gender:F
Credentials:MS NCC LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:902 LONGVIEW TER
Mailing Address - Street 2:
Mailing Address - City:CLARKS SUMMIT
Mailing Address - State:PA
Mailing Address - Zip Code:18411-8923
Mailing Address - Country:US
Mailing Address - Phone:570-586-9258
Mailing Address - Fax:
Practice Address - Street 1:1141 CLAY AVE
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18510-1191
Practice Address - Country:US
Practice Address - Phone:570-963-2079
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-22
Last Update Date:2011-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPCOO5940101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional