Healthcare Provider Details

I. General information

NPI: 1942163639
Provider Name (Legal Business Name): KAREN T. GRAVES CAC-2
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

806 BEAVER CIR
DOUGLAS GA
31533-2122
US

IV. Provider business mailing address

806 BEAVER CIR
DOUGLAS GA
31533-2122
US

V. Phone/Fax

Practice location:
  • Phone: 912-381-4841
  • Fax:
Mailing address:
  • Phone: 912-381-4841
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number3657
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: