MEDICARE: WHITNEY GRAVES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1184061574
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WHITNEY GRAVES

Provider Business Mailing Address
First Line	:	615 SHIPYARD BLVD
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28412-6431
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3375 S HOOVER ST
Second Line	:	SUITE H201
City	:	LOS ANGELES
State	:	CA
Zip	:	90089-0116
Country	:	US
Telephone Number	:	866-740-6502
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/27/2013
Last Update Date	:	11/10/2020

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Directions to “ WHITNEY GRAVES ” Practice Location

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