Individual
DR. AMANDA LEIGH GRAHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
EDD
Contact information
Practice address
1453 BIG HILL RD, PENNINGTON GAP, VA 24277-8133
(276) 393-9771
Mailing address
1453 BIG HILL RD, PENNINGTON GAP, VA 24277-8133
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
0710102168
VA
101YM0800X
Mental Health Counselor
0701005028
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NA
NA
VA
Enumeration date
01/16/2018
Last updated
01/16/2018
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