Provider Demographics
NPI:1053052217
Name:GRAHAM, KESHA DENEAN WALL (LISW-CP)
Entity type:Individual
Prefix:MS
First Name:KESHA
Middle Name:DENEAN WALL
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:LISW-CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4904 PINERIDGE RD
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485-8958
Mailing Address - Country:US
Mailing Address - Phone:843-303-7758
Mailing Address - Fax:
Practice Address - Street 1:4904 PINERIDGE RD
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29485-8958
Practice Address - Country:US
Practice Address - Phone:843-303-7758
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-03
Last Update Date:2022-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC93591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical