Provider Demographics
NPI:1710018361
Name:GRAVES, LORRAINE MILLELOT (M A, MTS, PHD)
Entity Type:Individual
Prefix:MS
First Name:LORRAINE
Middle Name:MILLELOT
Last Name:GRAVES
Suffix:
Gender:F
Credentials:M A, MTS, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2803 E CERVANTES ST
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-6389
Mailing Address - Country:US
Mailing Address - Phone:850-433-2042
Mailing Address - Fax:850-433-2782
Practice Address - Street 1:2803 E CERVANTES ST
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-6389
Practice Address - Country:US
Practice Address - Phone:850-433-2042
Practice Address - Fax:850-433-2782
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH01369101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health