1861637647 NPI number — MRS. REBECCA CRAWFORD GRAHAM MA, LPC, CACII

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861637647 NPI number — MRS. REBECCA CRAWFORD GRAHAM MA, LPC, CACII

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GRAHAM
Provider First Name:
REBECCA
Provider Middle Name:
CRAWFORD
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MA, LPC, CACII
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CRAWFORD
Provider Other First Name:
REBECCA
Provider Other Middle Name:
ALLEN
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1861637647
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/09/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
242 CREEKSTONE RDG
Provider Second Line Business Mailing Address:
SUITE 242
Provider Business Mailing Address City Name:
WOODSTOCK
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30188-3732
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
678-445-4184
Provider Business Mailing Address Fax Number:
678-445-5146

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
242 CREEKSTONE RDG
Provider Second Line Business Practice Location Address:
SUITE 242
Provider Business Practice Location Address City Name:
WOODSTOCK
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30188-3732
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
678-445-4184
Provider Business Practice Location Address Fax Number:
678-445-5146
Provider Enumeration Date:
12/09/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  003951 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 11893232 . This is a "CAQH" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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