Provider Demographics
NPI:1528305752
Name:GRAHAM, MARTHA ALISON (MED, LPCI)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:ALISON
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:MED, LPCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:273 COUNTRY CLUB RD
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:SC
Mailing Address - Zip Code:29571-6375
Mailing Address - Country:US
Mailing Address - Phone:843-992-0965
Mailing Address - Fax:
Practice Address - Street 1:273 COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:SC
Practice Address - Zip Code:29571-6375
Practice Address - Country:US
Practice Address - Phone:843-992-0965
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-08
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor