Individual
LINDA GRAHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2415 N 124TH CIR, AVONDALE, AZ 85323-6509
(602) 841-3438
Mailing address
2415 N 124TH CIR, AVONDALE, AZ 85323-6509
(602) 841-3438
Taxonomy
Speciality
Code
Description
License number
State
385HR2055X
Child Mental Illness Respite Care
Primary
10017
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
112550
AHCCCS ID
AZ
Enumeration date
12/01/2006
Last updated
07/08/2007
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