MEDICARE: CECILIA E GRAVES RESIDENT LPC

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	101YP2500X	Professional Counselor	0704015112	VA

General Provider Information

NPI Number	:	1639687361
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CECILIA E GRAVES RESIDENT LPC

Provider Business Mailing Address
First Line	:	2132 FORT BELVOIR DR
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23464-8748
Country	:	US
Telephone Number	:	360-239-1765
Fax Number	:

Provider Business Practice Location Address
First Line	:	2132 FORT BELVOIR DR
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23464-8748
Country	:	US
Telephone Number	:	360-239-1765
Fax Number	:

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

Provider Enumeration Date	:	01/16/2018
Last Update Date	:	01/07/2025

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