Healthcare Provider Details

I. General information

NPI: 1962019570
Provider Name (Legal Business Name): DAVID GRAVES JR. CDCA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2020
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 3RD AVE
CHESAPEAKE OH
45619-1144
US

IV. Provider business mailing address

307 4TH ST E APT 1A
SOUTH POINT OH
45680-8456
US

V. Phone/Fax

Practice location:
  • Phone: 740-451-0415
  • Fax: 800-480-7578
Mailing address:
  • Phone: 740-709-2210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCA.174405
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: