Provider Demographics
NPI:1578327623
Name:GRAVES, ROGER CLAYTON
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:CLAYTON
Last Name:GRAVES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4100 HYDE PARK DR
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23831-4826
Mailing Address - Country:US
Mailing Address - Phone:804-586-4471
Mailing Address - Fax:
Practice Address - Street 1:4610 STONEBROOK CT
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23060-3632
Practice Address - Country:US
Practice Address - Phone:804-586-4471
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-09
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health