Provider Demographics
NPI:1164936183
Name:GRAVES, CAITLYN (MSW, LSWA-IC)
Entity Type:Individual
Prefix:
First Name:CAITLYN
Middle Name:
Last Name:GRAVES
Suffix:
Gender:F
Credentials:MSW, LSWA-IC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1624 S I ST STE 305
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-5093
Mailing Address - Country:US
Mailing Address - Phone:253-428-8700
Mailing Address - Fax:
Practice Address - Street 1:1624 S I ST STE 305
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-5093
Practice Address - Country:US
Practice Address - Phone:253-428-8700
Practice Address - Fax:253-383-3376
Is Sole Proprietor?:No
Enumeration Date:2017-11-29
Last Update Date:2017-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASC60794648104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker