Provider Demographics
NPI:1316294390
Name:GRAHAM, MAUREEN ROSE (PHD LPC NCC)
Entity type:Individual
Prefix:DR
First Name:MAUREEN
Middle Name:ROSE
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:PHD LPC NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5199 BIRKDALE DR
Mailing Address - Street 2:
Mailing Address - City:COMMERCE TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48382-1582
Mailing Address - Country:US
Mailing Address - Phone:248-854-8462
Mailing Address - Fax:
Practice Address - Street 1:5199 BIRKDALE DR
Practice Address - Street 2:
Practice Address - City:COMMERCE TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48382-1582
Practice Address - Country:US
Practice Address - Phone:248-854-8462
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-09
Last Update Date:2014-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401010904101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional