Healthcare Provider Details

I. General information

NPI: 1295035178
Provider Name (Legal Business Name): JANICE MARIE GRAVES LLMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JANICE MARIE KING LLMSW

II. Dates (important events)

Enumeration Date: 10/26/2010
Last Update Date: 10/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2702 FLUSHING RD
FLINT MI
48504-4534
US

IV. Provider business mailing address

2267 COVERT RD
BURTON MI
48509-1014
US

V. Phone/Fax

Practice location:
  • Phone: 810-424-5998
  • Fax: 810-424-6347
Mailing address:
  • Phone: 810-424-5998
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801092495
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: