Healthcare Provider Details

I. General information

NPI: 1467363960
Provider Name (Legal Business Name): TYRONE GRAVES JR. LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 HUGUENOT RD STE 100
NORTH CHESTERFIELD VA
23235-4311
US

IV. Provider business mailing address

1901 HUGUENOT RD STE 100
NORTH CHESTERFIELD VA
23235-4311
US

V. Phone/Fax

Practice location:
  • Phone: 804-375-4350
  • Fax: 804-800-4483
Mailing address:
  • Phone: 804-375-4350
  • Fax: 804-800-4483

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0701016476
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: