Provider Demographics
NPI:1326082850
Name:GRAVES, ABBEY L (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ABBEY
Middle Name:L
Last Name:GRAVES
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 1:1240 BAMBERG COURT SUITE 3A
Mailing Address - Street 2:VILLAGE COUNSELING CENTER
Mailing Address - City:HANOVER PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60133
Mailing Address - Country:US
Mailing Address - Phone:630-372-6599
Mailing Address - Fax:
Practice Address - Street 1:1240 BAMBERG COURT SUITE 3A
Practice Address - Street 2:VILLAGE COUNSELING CENTER
Practice Address - City:HANOVER PARK
Practice Address - State:IL
Practice Address - Zip Code:60133
Practice Address - Country:US
Practice Address - Phone:847-372-6599
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2011-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071-005005103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL9844470003Medicare UPIN