Individual
DESHEA YVONNE GRAHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1 BOARS HEAD LN, CHARLOTTESVILLE, VA 22903-4681
(434) 202-4155
Mailing address
156 LEXIE LN, PALMYRA, VA 22963-2078
(703) 475-6179
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
0904010788
VA
1041C0700X
Clinical Social Worker
091318
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00355940
—
NY
01
—
1285628552
AGENCY
NY
01
—
14343049
CIGNA
VA
01
—
6776040
AETNA
VA
01
—
697861
ANTHEM BLUE CROSS BLUE SHIELD
VA
01
—
WVE061
MEDICARE #
NY
Enumeration date
02/17/2016
Last updated
12/30/2022
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