Provider Demographics
NPI:1386289361
Name:GRAHAM, GEOFFREY COOPER (LCSW)
Entity type:Individual
Prefix:
First Name:GEOFFREY
Middle Name:COOPER
Last Name:GRAHAM
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 BEVERLY AVE
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28792-5403
Mailing Address - Country:US
Mailing Address - Phone:443-690-5329
Mailing Address - Fax:
Practice Address - Street 1:848 MARCHETA ST
Practice Address - Street 2:
Practice Address - City:ALTADENA
Practice Address - State:CA
Practice Address - Zip Code:91001-2580
Practice Address - Country:US
Practice Address - Phone:443-690-5329
Practice Address - Fax:866-488-8170
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-13
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA860691041C0700X
NCC0162051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical