NPI | 1154476166 |
---|---|
Former Name | CAROL M GRAHAM |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: DE B1-0000719) |
Additional Taxonomies | 103T00000X Psychologist (Licence: DE B1-0000719) |
103TC0700X Psychologist, Clinical (Licence: PA PS015843) | |
Enumeration Date | 2007-01-23 |
Last Update Date | 2024-11-15 |