Individual
TANDREA GRAHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MSW
Contact information
Practice address
628 OLD WAGNER RD, PETERSBURG, VA 23805-9319
(804) 605-6146
Mailing address
3550 WESTBRIAR LN, NORTH DINWIDDIE, VA 23803-8422
(804) 605-6146
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
3442
VA
Other
Enumeration date
10/20/2020
Last updated
10/20/2020
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