Provider Demographics
NPI:1750573580
Name:GRAHAM, DONALD BRADLEY (MSW,MPA)
Entity type:Individual
Prefix:MR
First Name:DONALD
Middle Name:BRADLEY
Last Name:GRAHAM
Suffix:
Gender:M
Credentials:MSW,MPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6909 E HIGHWAY 22
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32404-2370
Mailing Address - Country:US
Mailing Address - Phone:850-874-0715
Mailing Address - Fax:850-874-0716
Practice Address - Street 1:6909 E HIGHWAY 22
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32404-2370
Practice Address - Country:US
Practice Address - Phone:850-874-0715
Practice Address - Fax:850-874-0716
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-15
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical