Provider Demographics
NPI:1215541321
Name:GRAVES, BROOKE M (CSAC-S QMHP-A)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:M
Last Name:GRAVES
Suffix:
Gender:F
Credentials:CSAC-S QMHP-A
Other - Prefix:
Other - First Name:BROOKE
Other - Middle Name:
Other - Last Name:WARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10543 S CRATER RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH PRINCE GEORGE
Mailing Address - State:VA
Mailing Address - Zip Code:23805-7333
Mailing Address - Country:US
Mailing Address - Phone:336-710-4407
Mailing Address - Fax:
Practice Address - Street 1:10543 S CRATER RD
Practice Address - Street 2:
Practice Address - City:SOUTH PRINCE GEORGE
Practice Address - State:VA
Practice Address - Zip Code:23805-7333
Practice Address - Country:US
Practice Address - Phone:804-431-5585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-04
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0709024366101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)