Individual
STACIE GRAHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BCBA
Contact information
Practice address
117 CASTAWAY CT NE, LUDOWICI, GA 31316-6294
(719) 460-1129
Mailing address
117 CASTAWAY CT NE, LUDOWICI, GA 31316-6294
(719) 460-1129
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-24-78469
GA
Other
Enumeration date
11/07/2019
Last updated
01/20/2025
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