Provider Demographics
NPI:1982354841
Name:GRAHAM, CHANNIN
Entity Type:Individual
Prefix:
First Name:CHANNIN
Middle Name:
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1070 CONCORD AVE STE 220
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94520-5648
Mailing Address - Country:US
Mailing Address - Phone:925-849-5087
Mailing Address - Fax:
Practice Address - Street 1:1070 CONCORD AVE STE 220
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-5648
Practice Address - Country:US
Practice Address - Phone:925-849-5087
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-24
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist