Basic Information
| Provider Information | |||||||||
| NPI: | 1548576630 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GRAHAM | ||||||||
| FirstName: | GREGORY | ||||||||
| MiddleName: | NEAL | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 724 BETHEL CHURCH RD | ||||||||
| Address2: | |||||||||
| City: | EVA | ||||||||
| State: | AL | ||||||||
| PostalCode: | 356218310 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2563261380 | ||||||||
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| Practice Location | |||||||||
| Address1: | 107 2ND AVE SE | ||||||||
| Address2: | |||||||||
| City: | CULLMAN | ||||||||
| State: | AL | ||||||||
| PostalCode: | 350553511 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2567394910 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/26/2010 | ||||||||
| LastUpdateDate: | 08/31/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/31/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 2465 | AL | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.