Provider Demographics
NPI:1295378602
Name:KIPPINS-GRAHAM, DAMARA JOI
Entity type:Individual
Prefix:
First Name:DAMARA
Middle Name:JOI
Last Name:KIPPINS-GRAHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 CARPENTER DR STE 110
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20164-4468
Mailing Address - Country:US
Mailing Address - Phone:703-297-4368
Mailing Address - Fax:
Practice Address - Street 1:107 CARPENTER DR STE 110
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20164-4468
Practice Address - Country:US
Practice Address - Phone:703-297-4368
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-18
Last Update Date:2019-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor