Provider Demographics
NPI:1083310155
Name:GRAVER, RHEANNA MARIE (LLMSW)
Entity Type:Individual
Prefix:
First Name:RHEANNA
Middle Name:MARIE
Last Name:GRAVER
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52970 POWELL LN APT 2
Mailing Address - Street 2:
Mailing Address - City:THREE RIVERS
Mailing Address - State:MI
Mailing Address - Zip Code:49093-8467
Mailing Address - Country:US
Mailing Address - Phone:269-718-4714
Mailing Address - Fax:
Practice Address - Street 1:343 S MAIN ST STE 211
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-2138
Practice Address - Country:US
Practice Address - Phone:734-412-7400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-01
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68511149891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical