Provider Demographics
NPI:1346900123
Name:GRAVES, SHERRY (LCSW, CADC11)
Entity Type:Individual
Prefix:PROF
First Name:SHERRY
Middle Name:
Last Name:GRAVES
Suffix:
Gender:F
Credentials:LCSW, CADC11
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4835 CLOVE DR SW
Mailing Address - Street 2:
Mailing Address - City:MABLETON
Mailing Address - State:GA
Mailing Address - Zip Code:30126-1186
Mailing Address - Country:US
Mailing Address - Phone:917-755-4264
Mailing Address - Fax:
Practice Address - Street 1:4835 CLOVE DR SW
Practice Address - Street 2:
Practice Address - City:MABLETON
Practice Address - State:GA
Practice Address - Zip Code:30126-1186
Practice Address - Country:US
Practice Address - Phone:917-755-4264
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-21
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0051171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical