Individual
STACY BRYANT GRAHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3310 MAGNOLIA ST, ORANGEBURG, SC 29115-1466
(803) 531-6900
(803) 531-6907
Mailing address
3310 MAGNOLIA ST., ORANGEBURG, SC 29115
(803) 531-6900
(803) 531-6907
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
376241
—
SC
Enumeration date
03/28/2007
Last updated
07/27/2022
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