Provider Demographics
NPI:1265302756
Name:GRAHAM, SIMONE ELAN
Entity type:Individual
Prefix:
First Name:SIMONE
Middle Name:ELAN
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 1:405 POPES CROSSING RD
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28358-8362
Mailing Address - Country:US
Mailing Address - Phone:512-290-3334
Mailing Address - Fax:
Practice Address - Street 1:2504 RAEFORD RD STE 201
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28305-5135
Practice Address - Country:US
Practice Address - Phone:910-916-3261
Practice Address - Fax:910-600-5090
Is Sole Proprietor?:No
Enumeration Date:2025-11-10
Last Update Date:2025-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician