Provider Demographics
NPI:1598175317
Name:GRAVEN, CAROL JEAN (CADC1)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:JEAN
Last Name:GRAVEN
Suffix:
Gender:F
Credentials:CADC1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3945 SE HAWTHORNE BLVD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-5241
Mailing Address - Country:US
Mailing Address - Phone:503-839-9462
Mailing Address - Fax:
Practice Address - Street 1:3945 SE HAWTHORNE BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-5241
Practice Address - Country:US
Practice Address - Phone:503-839-9462
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-01
Last Update Date:2014-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR12-03-23101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)