Provider Demographics
NPI:1316296874
Name:GRAHAM, BARRY WALSTER (LCASA)
Entity type:Individual
Prefix:
First Name:BARRY
Middle Name:WALSTER
Last Name:GRAHAM
Suffix:
Gender:M
Credentials:LCASA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 DOLL ST
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:NC
Mailing Address - Zip Code:28337-9561
Mailing Address - Country:US
Mailing Address - Phone:910-879-0006
Mailing Address - Fax:910-879-0012
Practice Address - Street 1:732 DAVIS AVE
Practice Address - Street 2:
Practice Address - City:WHITEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28472-6002
Practice Address - Country:US
Practice Address - Phone:910-640-1038
Practice Address - Fax:910-640-1465
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-30
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2720AOtherNCSAPPB