Provider Demographics
NPI:1255004032
Name:GRAVES HOPKINS, CLARA
Entity Type:Individual
Prefix:
First Name:CLARA
Middle Name:
Last Name:GRAVES HOPKINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2475 PALM BAY RD NE STE 27
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32905-3317
Mailing Address - Country:US
Mailing Address - Phone:407-435-7047
Mailing Address - Fax:
Practice Address - Street 1:2475 PALM BAY RD NE STE 27
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32905-3317
Practice Address - Country:US
Practice Address - Phone:407-435-7047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-28
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)