Individual
AMANDA JEAN GRAHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSBS, LCADC
Contact information
Practice address
100 DIECKS DR, ELIZABETHTOWN, KY 42701-2443
(580) 726-2452
(580) 726-2483
Mailing address
100 DIECKS DR, ELIZABETHTOWN, KY 42701-2443
(270) 238-1485
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
291034
KY
Other
Enumeration date
05/11/2017
Last updated
03/10/2024
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