Provider Demographics
NPI:1366994360
Name:GRAHAM, LORI BIRCH (LPC)
Entity type:Individual
Prefix:MS
First Name:LORI
Middle Name:BIRCH
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17042 MICHAELS HILL RD
Mailing Address - Street 2:
Mailing Address - City:MELFA
Mailing Address - State:VA
Mailing Address - Zip Code:23410
Mailing Address - Country:US
Mailing Address - Phone:757-302-1327
Mailing Address - Fax:
Practice Address - Street 1:19056 GREENBUSH RD
Practice Address - Street 2:
Practice Address - City:PARKSLEY
Practice Address - State:VA
Practice Address - Zip Code:23421
Practice Address - Country:US
Practice Address - Phone:757-302-1327
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-26
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701006724101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health