Provider Demographics
NPI:1245887868
Name:GRAHAM, ERICA
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ERICA
Other - Middle Name:
Other - Last Name:BUTLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:105 BRADFORD SQUARE
Mailing Address - Street 2:STE A
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30215-1974
Mailing Address - Country:US
Mailing Address - Phone:770-742-3846
Mailing Address - Fax:770-742-3855
Practice Address - Street 1:105 BRADFORD SQ STE A
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30215-1974
Practice Address - Country:US
Practice Address - Phone:770-742-3876
Practice Address - Fax:770-742-3855
Is Sole Proprietor?:No
Enumeration Date:2019-08-19
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)