Provider Demographics
NPI:1265551519
Name:GRAHAM, JASMINE (MFTA)
Entity type:Individual
Prefix:MS
First Name:JASMINE
Middle Name:
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:MFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1328 ABBOTTS CREEK CIRCLE
Mailing Address - Street 2:
Mailing Address - City:KERNERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27284
Mailing Address - Country:US
Mailing Address - Phone:336-549-8894
Mailing Address - Fax:
Practice Address - Street 1:7900 TRIAD CENTER DRIVE
Practice Address - Street 2:SUITE 350
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27409
Practice Address - Country:US
Practice Address - Phone:336-931-1805
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health