Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 6401010374 | MI |
NPI | 1003045956 |
---|---|
Provider Name | Stacey L Graham |
First Address | Alma, MI 48801-0069 |
Second Address | Alma, MI 48801-1600 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2009 |
Last Update Date | 10/05/2013 |