Provider Demographics
NPI:1437865516
Name:GRAVES, CAROLINE (APC)
Entity Type:Individual
Prefix:MISS
First Name:CAROLINE
Middle Name:
Last Name:GRAVES
Suffix:
Gender:F
Credentials:APC
Other - Prefix:MRS
Other - First Name:CAROLINE
Other - Middle Name:G
Other - Last Name:LOWE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APC
Mailing Address - Street 1:45 W CROSSVILLE RD STE 514B
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-2964
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:45 W CROSSVILLE RD STE 514B
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-2964
Practice Address - Country:US
Practice Address - Phone:770-702-2982
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-23
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA008880101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty