NPIMap

Organization Active NPI

Dewberry Graham LLC

  • Psychiatry Physician
  • Knightdale, NC
National Provider Identifier
1962665406
Registry record updated Oct 30, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
DEWBERRY GRAHAM LLC
Practice address
6845 Knightdale Blvd
Ste 104
Knightdale, NC 27545-9651
Phone
(919) 217-0061
Fax
(919) 217-0069
NPI assigned
Jul 3, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 30, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ronetta Graham, LPCNPI 1386792885
Title
Owner
Phone
(919) 217-0061

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Professional CounselorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 101YP2500X
Clinical Social WorkerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1041C0700X
Psychiatry PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 2084P0800X Primary

Addresses

Primary practice location

6845 Knightdale Blvd
Ste 104
Knightdale, NC 27545-9651

Mailing address

6845 Knightdale Blvd
Ste 104
Knightdale, NC 27545-9651
Phone (919) 217-0061

Other identifiers 2

IdentifierTypeStateIssuer
6006458MedicaidNC
5917583MedicaidNC

National Provider Directory

National Provider Directory

Locations

6845 Knightdale Blvd
Ste 104
Knightdale, NC 27545
Phone (919) 217-0061

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1215043200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1446163200000",
    "number": "1962665406",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6845 KNIGHTDALE BLVD",
            "address_2": "STE 104",
            "city": "KNIGHTDALE",
            "state": "NC",
            "postal_code": "275459651",
            "telephone_number": "919-217-0061",
            "fax_number": "919-217-0069"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6845 KNIGHTDALE BLVD",
            "address_2": "STE 104",
            "city": "KNIGHTDALE",
            "state": "NC",
            "postal_code": "275459651",
            "telephone_number": "919-217-0061",
            "fax_number": "919-217-0069"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEWBERRY GRAHAM LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-07-03",
        "last_updated": "2015-10-30",
        "status": "A",
        "authorized_official_last_name": "GRAHAM",
        "authorized_official_first_name": "RONETTA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "919-217-0061",
        "authorized_official_credential": "LPC"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6006458",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5917583",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Knightdale, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.