Individual
KENSIE BRIELLE GRAHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CASAC-T
Contact information
Practice address
1519 NYE RD, LYONS, NY 14489-9133
(315) 946-5722
Mailing address
1519 NYE RD, LYONS, NY 14489-9133
(315) 946-5722
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
37456
NY
Other
Enumeration date
04/21/2023
Last updated
05/02/2023
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