Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 3470 | NC |
NPI | 1487838280 |
---|---|
Provider Name | Ms. Lee Covington Graham |
First Address | Wilmington, NC 28412-6431 |
Second Address | Wilmington, NC 28412-6431 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/12/2007 |
Last Update Date | 28/12/2007 |