Provider Demographics
NPI:1790490308
Name:GRAVES, GARRETT MAXWELL (LMHC)
Entity Type:Individual
Prefix:
First Name:GARRETT
Middle Name:MAXWELL
Last Name:GRAVES
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 WOOD HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32724-9749
Mailing Address - Country:US
Mailing Address - Phone:678-429-5288
Mailing Address - Fax:
Practice Address - Street 1:1121 N DIXIE FWY
Practice Address - Street 2:
Practice Address - City:NEW SMYRNA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32168-6069
Practice Address - Country:US
Practice Address - Phone:386-822-8841
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-18
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH21719101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty