Provider Demographics
NPI:1487491254
Name:LACEY GRAFFAM
Entity type:Organization
Organization Name:LACEY GRAFFAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LCPC
Authorized Official - Prefix:
Authorized Official - First Name:LACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAFFAM
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:207-432-4007
Mailing Address - Street 1:175 DEER CROSSING RD
Mailing Address - Street 2:
Mailing Address - City:LIMERICK
Mailing Address - State:ME
Mailing Address - Zip Code:04048-3418
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:175 DEER CROSSING RD
Practice Address - Street 2:
Practice Address - City:LIMERICK
Practice Address - State:ME
Practice Address - Zip Code:04048-3418
Practice Address - Country:US
Practice Address - Phone:207-432-4007
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-10
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty