Provider Demographics
NPI:1134619059
Name:GRAVES, VANESSA (LICSW, PIP)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:GRAVES
Suffix:
Gender:F
Credentials:LICSW, PIP
Other - Prefix:MRS
Other - First Name:VANESSA
Other - Middle Name:GERMAN
Other - Last Name:GRAVES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCSW
Mailing Address - Street 1:521 ENERGY CENTER BLVD STE 1506
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:AL
Mailing Address - Zip Code:35473-5833
Mailing Address - Country:US
Mailing Address - Phone:205-737-7678
Mailing Address - Fax:205-737-7681
Practice Address - Street 1:521 ENERGY CENTER BLVD STE 1506
Practice Address - Street 2:
Practice Address - City:NORTHPORT
Practice Address - State:AL
Practice Address - Zip Code:35473
Practice Address - Country:US
Practice Address - Phone:205-737-7678
Practice Address - Fax:205-737-7681
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-16
Last Update Date:2018-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL0996C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical