Provider Demographics
NPI:1811389307
Name:GRAHAM, CARRIE (MA)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1057 PATRICK DR
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-8459
Mailing Address - Country:US
Mailing Address - Phone:843-713-9854
Mailing Address - Fax:
Practice Address - Street 1:1505 HERITAGE LN
Practice Address - Street 2:SUITE B
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29505-3141
Practice Address - Country:US
Practice Address - Phone:843-667-1905
Practice Address - Fax:843-667-1723
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-20
Last Update Date:2022-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPC1797Medicaid