Provider Demographics
NPI:1316275548
Name:LEE-GRAHAM, AMEKA MICHELLE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:AMEKA
Middle Name:MICHELLE
Last Name:LEE-GRAHAM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2211 TODDS LN
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-3146
Mailing Address - Country:US
Mailing Address - Phone:757-778-3012
Mailing Address - Fax:
Practice Address - Street 1:2211 TODDS LN
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-3146
Practice Address - Country:US
Practice Address - Phone:757-778-3012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-30
Last Update Date:2016-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040072491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1316275548Medicaid