Provider Demographics
NPI:1609150960
Name:GRAVES, ANDREA MICHELLE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:MICHELLE
Last Name:GRAVES
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:200 S FRONTAGE RD
Mailing Address - Street 2:STE 320
Mailing Address - City:BURR RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60527-6953
Mailing Address - Country:US
Mailing Address - Phone:630-337-8006
Mailing Address - Fax:630-581-5984
Practice Address - Street 1:1 QUALITY DR
Practice Address - Street 2:DEPARTMENT OF PSYCHIATRY
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95688-9494
Practice Address - Country:US
Practice Address - Phone:707-624-2830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-05
Last Update Date:2020-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY26348OtherLICENSE- BOARD OF PSYCHOLOGY