Doctor Name: | GLORIA GRAHAM |
NPI Number: | 1376704866 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | 25587 |
Business Practice Address: | 7922 Palm St Lemon Grove, CA - 919452956 |
Business Phone Number: | 6194643488 |
Business Fax Number: | |
Mailing Address: | 4355 46th St, #16 SAN DIEGO |
State: | CA |
Postal Code: | 921154349 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 06/18/2008 |
NPI Last Update Date: | 06/18/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 167G00000X |
License Number: | 25587 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Nursing Service Providers |
Taxonomy Classification: | Licensed Psychiatric Technician |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual licensed by the state board as a Psychiatric Technician based upon completion of a prescribed course of theory and clinical practice, with two thirds of the clinical practice time focused on mental and developmental disorders. The psychiatric technician practices under the direct supervision of a physician, psychologist, registered nurse or other professional to provide care to patients with mental disorders and developmental disabilities. |