Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | C007323 | NC |
NPI | 1003148446 |
---|---|
Provider Name | Carlos Devone Graham |
First Address | Savannah, GA 31406-3662 |
Second Address | Savannah, GA 31406-3662 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/02/2010 |
Last Update Date | 06/02/2018 |