Individual
JEMICEO GRAHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCAS-A
Contact information
Practice address
2706 N CHURCH ST, GREENSBORO, NC 27405-3657
(336) 272-9990
Mailing address
3410 HEALY DR, SUITE 117, WINSTON SALEM, NC 27103-1403
(336) 768-7936
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
LCAS-A 21464
NC
171M00000X
Case Manager/Care Coordinator
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Other
Enumeration date
01/30/2015
Last updated
07/19/2019
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