Healthcare Provider Details

I. General information

NPI: 1770406233
Provider Name (Legal Business Name): CANDACE GRAVES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8302 WINGHAVEN POINTE DR
O FALLON MO
63368-7656
US

IV. Provider business mailing address

8302 WINGHAVEN POINTE DR
O FALLON MO
63368-7656
US

V. Phone/Fax

Practice location:
  • Phone: 802-949-0918
  • Fax:
Mailing address:
  • Phone: 802-949-0918
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: CANDACE GRAVES
Title or Position: CEO
Credential:
Phone: 802-949-0918