Provider Demographics
NPI:1528445475
Name:GRAHAM, ALLYSON (BA)
Entity type:Individual
Prefix:
First Name:ALLYSON
Middle Name:
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:BA
Other - Prefix:MISS
Other - First Name:ALLISON
Other - Middle Name:MEGAN
Other - Last Name:GRAHAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BA
Mailing Address - Street 1:1358 NORWALK ST APT M
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27407-1935
Mailing Address - Country:US
Mailing Address - Phone:404-704-7348
Mailing Address - Fax:
Practice Address - Street 1:3724 S GALVEZ ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70125
Practice Address - Country:US
Practice Address - Phone:404-704-7348
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-29
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
NCA15996101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No171M00000XOther Service ProvidersCase Manager/Care Coordinator