Provider Demographics
NPI:1144902768
Name:GRAHAM, REBECCA (PHD)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:BECCA
Other - Middle Name:
Other - Last Name:GRAHAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:374 N COAST HIGHWAY 101
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-2542
Mailing Address - Country:US
Mailing Address - Phone:858-771-0556
Mailing Address - Fax:
Practice Address - Street 1:374 N COAST HIGHWAY 101
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-2542
Practice Address - Country:US
Practice Address - Phone:858-771-0556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-03
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35785103TC1900X
NY009789101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health