Provider Demographics
NPI:1639829245
Name:GRAVES, CARLA DENISE (DOULA)
Entity Type:Individual
Prefix:MS
First Name:CARLA
Middle Name:DENISE
Last Name:GRAVES
Suffix:
Gender:F
Credentials:DOULA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1614 E STATE ST APT 2
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08609-1812
Mailing Address - Country:US
Mailing Address - Phone:609-859-6070
Mailing Address - Fax:
Practice Address - Street 1:1614 E STATE ST APT 2
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08609-1812
Practice Address - Country:US
Practice Address - Phone:609-859-6070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-26
Last Update Date:2022-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ374500000X374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Single Specialty