Provider Demographics
NPI:1114129178
Name:GRAVES, JUDY BRANNAN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JUDY
Middle Name:BRANNAN
Last Name:GRAVES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 WENTWOOD VALLEY DR APT 104
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72212-3651
Mailing Address - Country:US
Mailing Address - Phone:501-225-6433
Mailing Address - Fax:501-225-6433
Practice Address - Street 1:2401 WENTWOOD VALLEY DR APT 104
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72212-3651
Practice Address - Country:US
Practice Address - Phone:501-225-6433
Practice Address - Fax:501-225-6433
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC-1021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5S716OtherBLUE CROSS - BLUE SHIELD