Provider Demographics
NPI:1912620048
Name:GRAHAM, BENJAMIN NEIL (ALC)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:NEIL
Last Name:GRAHAM
Suffix:
Gender:M
Credentials:ALC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4729 BANKHEAD CT
Mailing Address - Street 2:
Mailing Address - City:IRONDALE
Mailing Address - State:AL
Mailing Address - Zip Code:35210-2403
Mailing Address - Country:US
Mailing Address - Phone:205-577-0314
Mailing Address - Fax:
Practice Address - Street 1:277 VILLAGE PKWY
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:AL
Practice Address - Zip Code:35080-4028
Practice Address - Country:US
Practice Address - Phone:205-624-3076
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-23
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health