Provider Demographics
NPI:1700971389
Name:GRAVES, SANDRA LEE (MFT)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:LEE
Last Name:GRAVES
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:593-A EAST ELDER ST.
Mailing Address - Street 2:
Mailing Address - City:FALLBROOK
Mailing Address - State:CA
Mailing Address - Zip Code:92028
Mailing Address - Country:US
Mailing Address - Phone:760-723-0048
Mailing Address - Fax:760-728-0095
Practice Address - Street 1:593-A EAST ELDER ST.
Practice Address - Street 2:
Practice Address - City:FALLBROOK
Practice Address - State:CA
Practice Address - Zip Code:92028
Practice Address - Country:US
Practice Address - Phone:760-723-0048
Practice Address - Fax:760-728-0095
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40520106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist