Healthcare Provider Details

I. General information

NPI: 1982567376
Provider Name (Legal Business Name): MS. KIMBERLY YAVETTE GRAVES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2025
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11770 HAYNES BRIDGE RD STE 205-411
ALPHARETTA GA
30009-1966
US

IV. Provider business mailing address

11770 HAYNES BRIDGE RD STE 205-411
ALPHARETTA GA
30009-1966
US

V. Phone/Fax

Practice location:
  • Phone: 678-264-3988
  • Fax:
Mailing address:
  • Phone: 678-264-3988
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAPC008985
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: