Provider Demographics
NPI:1295035178
Name:GRAVES, JANICE MARIE (LLMSW)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:MARIE
Last Name:GRAVES
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:JANICE
Other - Middle Name:MARIE
Other - Last Name:KING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LLMSW
Mailing Address - Street 1:2267 COVERT RD
Mailing Address - Street 2:
Mailing Address - City:BURTON
Mailing Address - State:MI
Mailing Address - Zip Code:48509-1014
Mailing Address - Country:US
Mailing Address - Phone:810-424-5998
Mailing Address - Fax:
Practice Address - Street 1:2702 FLUSHING RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48504-4534
Practice Address - Country:US
Practice Address - Phone:810-424-5998
Practice Address - Fax:810-424-6347
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-26
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010924951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical