Provider Demographics
NPI:1396451878
Name:GRAHAM, SHANI (MS, NCC, LCMHCA)
Entity type:Individual
Prefix:
First Name:SHANI
Middle Name:
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:MS, NCC, LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4888 MONTEVISTA DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27407-9716
Mailing Address - Country:US
Mailing Address - Phone:201-838-7756
Mailing Address - Fax:
Practice Address - Street 1:106 S FOURTH ST STE A
Practice Address - Street 2:
Practice Address - City:MEBANE
Practice Address - State:NC
Practice Address - Zip Code:27302-2653
Practice Address - Country:US
Practice Address - Phone:919-649-3952
Practice Address - Fax:336-376-6425
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-27
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA18496101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health