Provider Demographics
NPI:1497999494
Name:GRAVES, LYNN GARLOCK (LPC)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:GARLOCK
Last Name:GRAVES
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:984 THREE TREES RD
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29412-4924
Mailing Address - Country:US
Mailing Address - Phone:843-795-5679
Mailing Address - Fax:843-795-8290
Practice Address - Street 1:1242 PAULINE AVE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29412-4030
Practice Address - Country:US
Practice Address - Phone:843-795-0238
Practice Address - Fax:843-795-8290
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-22
Last Update Date:2009-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2652101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional