Individual
CRYSTAL SHAMAR GRAHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCAS
Contact information
Practice address
8025 N POINT BLVD STE 283, WINSTON SALEM, NC 27106-3860
(336) 842-3396
(336) 245-1804
Mailing address
8025 N POINT BLVD STE 283, WINSTON SALEM, NC 27106-3860
(336) 920-1481
(336) 245-1804
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1235876988
—
NC
05
—
1952879827
—
NC
05
—
25548833
—
NC
Enumeration date
11/08/2018
Last updated
11/15/2024
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