Healthcare Provider Details

I. General information

NPI: 1427089671
Provider Name (Legal Business Name): KRISTIN ELIZABETH GRAPES PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 06/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2910 BRIARCLIFF ROAD
WINSTON SALEM NC
27106-3176
US

IV. Provider business mailing address

2910 BRIARCLIFFE RD SUITE 604-B
WINSTON SALEM NC
27106-3176
US

V. Phone/Fax

Practice location:
  • Phone: 336-407-6764
  • Fax:
Mailing address:
  • Phone: 336-407-6764
  • Fax: 336-773-0332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number673
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: