Healthcare Provider Details

I. General information

NPI: 1033552393
Provider Name (Legal Business Name): DARCI M. GRAVES LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2013
Last Update Date: 04/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 6TH ST
LEWISTON ID
83501-2431
US

IV. Provider business mailing address

415 6TH ST
LEWISTON ID
83501-2431
US

V. Phone/Fax

Practice location:
  • Phone: 208-799-6500
  • Fax:
Mailing address:
  • Phone: 208-799-6500
  • Fax: 208-799-5758

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLMSW-31423
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: