Provider Demographics
NPI:1447962246
Name:GRAHAM, DEZNIQUE
Entity type:Individual
Prefix:
First Name:DEZNIQUE
Middle Name:
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5046 GRAYS CREEK CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:HOPE MILLS
Mailing Address - State:NC
Mailing Address - Zip Code:28348-7812
Mailing Address - Country:US
Mailing Address - Phone:910-493-3555
Mailing Address - Fax:910-493-3520
Practice Address - Street 1:5046 GRAYS CREEK CHURCH RD
Practice Address - Street 2:
Practice Address - City:HOPE MILLS
Practice Address - State:NC
Practice Address - Zip Code:28348-7812
Practice Address - Country:US
Practice Address - Phone:910-493-3555
Practice Address - Fax:910-493-3520
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-23
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0191741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical