Provider Demographics
NPI:1770157349
Name:GRAVES, ALEXANDRA JACQUELINE (LCSW)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:JACQUELINE
Last Name:GRAVES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1100 WILFORD HALL LOOP BLDG 455459
Mailing Address - Street 2:
Mailing Address - City:JBSA LACKLAND
Mailing Address - State:TX
Mailing Address - Zip Code:78236-5638
Mailing Address - Country:US
Mailing Address - Phone:210-292-5972
Mailing Address - Fax:
Practice Address - Street 1:WILFORD HALL AMBULATORY SURGICAL CENTER,
Practice Address - Street 2:1100 WILFORD HALL LOOP, BLDG. 4554
Practice Address - City:JBSA LACKLAND
Practice Address - State:TX
Practice Address - Zip Code:78236-3308
Practice Address - Country:US
Practice Address - Phone:210-292-5972
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-18
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1052931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical