Provider Demographics
NPI:1215140132
Name:GRAHAM, BRENDA B (PHD)
Entity type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:B
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 MARSH POINT DR
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-3218
Mailing Address - Country:US
Mailing Address - Phone:912-604-5967
Mailing Address - Fax:912-353-8349
Practice Address - Street 1:330 HODGSON CT
Practice Address - Street 2:SUITE B
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-2569
Practice Address - Country:US
Practice Address - Phone:912-604-5967
Practice Address - Fax:912-353-8349
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA06048213101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral