Basic Information
Provider Information
NPI: 1033481890
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GRAHAM
FirstName: PAMELA
MiddleName: PAGE
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 2187
Address2:  
City: SYLVA
State: NC
PostalCode: 287792187
CountryCode: US
TelephoneNumber: 8286313973
FaxNumber: 8286319280
Practice Location
Address1: 674 HIGHLANDS RD
Address2:  
City: FRANKLIN
State: NC
PostalCode: 287349566
CountryCode: US
TelephoneNumber: 8286313973
FaxNumber: 8286319280
Other Information
ProviderEnumerationDate: 02/08/2012
LastUpdateDate: 10/12/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1041C0700XC008820NCY Behavioral Health & Social Service ProvidersSocial WorkerClinical

No ID Information.


Home