Provider Demographics
NPI:1831545474
Name:GRAHAM, DAMON JR (LCSW)
Entity type:Individual
Prefix:MR
First Name:DAMON
Middle Name:
Last Name:GRAHAM
Suffix:JR
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:635 MYRON HART RD
Mailing Address - Street 2:
Mailing Address - City:COOLIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:31738-2143
Mailing Address - Country:US
Mailing Address - Phone:229-224-0655
Mailing Address - Fax:229-941-5865
Practice Address - Street 1:635 MYRON HART RD
Practice Address - Street 2:
Practice Address - City:COOLIDGE
Practice Address - State:GA
Practice Address - Zip Code:31738-2143
Practice Address - Country:US
Practice Address - Phone:229-224-0655
Practice Address - Fax:229-941-5865
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-12
Last Update Date:2016-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0057671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical