Provider Demographics
NPI:1548576630
Name:GRAHAM, GREGORY NEAL (LPC)
Entity type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:NEAL
Last Name:GRAHAM
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2699 SANDLIN RD SW STE A3
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35601-7343
Mailing Address - Country:US
Mailing Address - Phone:256-686-3984
Mailing Address - Fax:256-686-2322
Practice Address - Street 1:2699 SANDLIN RD SW STE A3
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601-7343
Practice Address - Country:US
Practice Address - Phone:256-686-3984
Practice Address - Fax:256-686-2322
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-26
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2465101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional