Provider Demographics
NPI:1013214071
Name:GRAVES, CAROLYN (LCMHC)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:GRAVES
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 HILL ST
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VT
Mailing Address - Zip Code:05828-9578
Mailing Address - Country:US
Mailing Address - Phone:802-227-9007
Mailing Address - Fax:
Practice Address - Street 1:133 HILL ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VT
Practice Address - Zip Code:05828-9578
Practice Address - Country:US
Practice Address - Phone:802-227-9007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-26
Last Update Date:2011-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT068.0055522101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health