Individual
KELLIE GRAHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
X
Credential
PPS
Contact information
Practice address
1711 MISSION DR, ANTIOCH, CA 94509-4599
(925) 779-7435
Mailing address
1711 MISSION DR, ANTIOCH, CA 94509-4599
(925) 779-7435
Taxonomy
Speciality
Code
Description
License number
State
101YS0200X
School Counselor
Primary
—
CA
Other
Enumeration date
03/17/2025
Last updated
03/17/2025
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