Provider Demographics
NPI:1073270625
Name:GRAVES, SHANNON JUSTINE (LPC, LIMHP)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:JUSTINE
Last Name:GRAVES
Suffix:
Gender:F
Credentials:LPC, LIMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1405 S FERN ST # 250
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22202-2810
Mailing Address - Country:US
Mailing Address - Phone:703-829-6418
Mailing Address - Fax:
Practice Address - Street 1:3426 JOANN AVE # 250
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68123-1354
Practice Address - Country:US
Practice Address - Phone:703-829-6418
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-18
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701011012101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health