Provider Demographics
NPI:1336573344
Name:JONES, SHAVAUN GRAVES (PCC)
Entity Type:Individual
Prefix:
First Name:SHAVAUN
Middle Name:GRAVES
Last Name:JONES
Suffix:
Gender:F
Credentials:PCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:273 E JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:PAINESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44077-4042
Mailing Address - Country:US
Mailing Address - Phone:440-709-0053
Mailing Address - Fax:440-709-0583
Practice Address - Street 1:273 E JACKSON ST
Practice Address - Street 2:
Practice Address - City:PAINESVILLE
Practice Address - State:OH
Practice Address - Zip Code:44077-4042
Practice Address - Country:US
Practice Address - Phone:440-709-0053
Practice Address - Fax:440-709-0583
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-27
Last Update Date:2013-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.0800148101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health