Provider Demographics
NPI:1649810003
Name:GRAVES, KRYSTAL RENEE' (MS, CRC, LPCA)
Entity type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:RENEE'
Last Name:GRAVES
Suffix:
Gender:F
Credentials:MS, CRC, LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 PRINCE ST
Mailing Address - Street 2:
Mailing Address - City:CARRBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27510-2215
Mailing Address - Country:US
Mailing Address - Phone:919-360-2585
Mailing Address - Fax:
Practice Address - Street 1:109 PRINCE ST
Practice Address - Street 2:
Practice Address - City:CARRBORO
Practice Address - State:NC
Practice Address - Zip Code:27510-2215
Practice Address - Country:US
Practice Address - Phone:919-360-2585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-13
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA15429101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health