Healthcare Provider Details

I. General information

NPI: 1669695334
Provider Name (Legal Business Name): HAROLD M GRAVES III LCSW-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 03/07/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

604 S. FREDERICK ROAD #213
GAITHERSBURG MD
20877-1282
US

IV. Provider business mailing address

23524 ROLLING FORK WAY
GAITHERSBURG MD
20882-2838
US

V. Phone/Fax

Practice location:
  • Phone: 301-424-3480
  • Fax: 410-334-6960
Mailing address:
  • Phone: 443-397-7767
  • Fax: 410-334-6960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberMD10165
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: