Provider Demographics
NPI:1861637647
Name:GRAHAM, REBECCA CRAWFORD (MA, LPC, CACII)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:CRAWFORD
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:MA, LPC, CACII
Other - Prefix:MS
Other - First Name:REBECCA
Other - Middle Name:ALLEN
Other - Last Name:CRAWFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:242 CREEKSTONE RDG
Mailing Address - Street 2:SUITE 242
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-3732
Mailing Address - Country:US
Mailing Address - Phone:678-445-4184
Mailing Address - Fax:678-445-5146
Practice Address - Street 1:242 CREEKSTONE RDG
Practice Address - Street 2:SUITE 242
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-3732
Practice Address - Country:US
Practice Address - Phone:678-445-4184
Practice Address - Fax:678-445-5146
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-09
Last Update Date:2008-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003951101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA11893232OtherCAQH