Provider Demographics
NPI:1740686757
Name:GRAHAM, HEATHER JOIE (LCSW)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:JOIE
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2420 ELMHURST BLVD NW
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30152-6008
Mailing Address - Country:US
Mailing Address - Phone:404-643-6205
Mailing Address - Fax:
Practice Address - Street 1:707 WHITLOCK AVE SW STE 28
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-3000
Practice Address - Country:US
Practice Address - Phone:404-643-6205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-18
Last Update Date:2020-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0044071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical