Provider Demographics
NPI:1649029380
Name:CALLOWAY-GRAHAM, MARCIA DIANE (PHD)
Entity type:Individual
Prefix:DR
First Name:MARCIA
Middle Name:DIANE
Last Name:CALLOWAY-GRAHAM
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6055
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84341-6055
Mailing Address - Country:US
Mailing Address - Phone:435-932-8880
Mailing Address - Fax:
Practice Address - Street 1:1525 N 200 W
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84341-2032
Practice Address - Country:US
Practice Address - Phone:435-752-8880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-15
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical