Most Relevant Information
Provider Data
| NPI Number: | 1003329798 |
| Provider Name: | VON RICHARD GRAHAM LCDCII |
| Entity Type: | Individual |
| Taxonomy Code: | 101YA0400X |
| Specialty: | Counselor |
| License Number: | LCDCII.161842 |
Most Important Dates
| Enumeration Date: | 11/16/2017 |
| Last Updated: | 01/26/2023 |
Provider Practice Location
547 E 11TH AVE
COLUMBUS
OH
432112603
Practice Location Phone/Fax
| Phone: | 6142244506 |
| Fax: | 6142910118 |
Provider Mailing Location
547 E 11TH AVE
COLUMBUS
OH
432112603
Provider Mailing Phone/Fax
| Phone: | 6142244506 |
| Fax: | 6142910118 |