Provider Demographics
NPI:1629811179
Name:GRAVES, LAURA DUVALL LOPES (MS)
Entity type:Individual
Prefix:MISS
First Name:LAURA
Middle Name:DUVALL LOPES
Last Name:GRAVES
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10712 BALLANTRAYE DR STE 310
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22407-4702
Mailing Address - Country:US
Mailing Address - Phone:540-784-1973
Mailing Address - Fax:571-348-1361
Practice Address - Street 1:10712 BALLANTRAYE DR STE 310
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22407-4702
Practice Address - Country:US
Practice Address - Phone:540-784-1973
Practice Address - Fax:571-348-1361
Is Sole Proprietor?:No
Enumeration Date:2024-06-13
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0704016932101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional