Healthcare Provider Details

I. General information

NPI: 1013214071
Provider Name (Legal Business Name): CAROLYN GRAVES LCMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2011
Last Update Date: 02/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 HILL ST
DANVILLE VT
05828-9578
US

IV. Provider business mailing address

133 HILL ST
DANVILLE VT
05828-9578
US

V. Phone/Fax

Practice location:
  • Phone: 802-227-9007
  • Fax:
Mailing address:
  • Phone: 802-227-9007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number068.0055522
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: