Provider Demographics
NPI:1205816139
Name:GRAVERS, ILONA NORA (PSYD)
Entity Type:Individual
Prefix:
First Name:ILONA
Middle Name:NORA
Last Name:GRAVERS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 710336
Mailing Address - Street 2:
Mailing Address - City:OAK HILL
Mailing Address - State:VA
Mailing Address - Zip Code:20171-0336
Mailing Address - Country:US
Mailing Address - Phone:703-303-2855
Mailing Address - Fax:703-464-0452
Practice Address - Street 1:8700 CENTREVILLE RD
Practice Address - Street 2:STE 410
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-8430
Practice Address - Country:US
Practice Address - Phone:703-303-2855
Practice Address - Fax:703-464-0452
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810002941103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist