Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1041C0700X | Clinical Social Worker | C7013 | MS |
Y | 1041C0700X | Clinical Social Worker | KY-903 | KY |
NPI | 1003060682 |
---|---|
Provider Name | Dr. Eurone Graham |
First Address | Martinsburg, WV 25405-9990 |
Second Address | Martinsburg, WV 25405-9990 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/11/2008 |
Last Update Date | 10/11/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
613 | VETERANS ADMINISTRATION (01) | WV |