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General NPI Number Information
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NPI Number | 1326504804
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Entity Type | Organization
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Legal Business Name | KRISTA GRAVATT LMSW, LLC
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Dates
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Enumeration Date | 02/20/2019
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Last Update Date | 02/20/2019
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Provider Practice Location Address
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Address Line | 455 E EISENHOWER PKWY STE 30
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City | ANN ARBOR
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State | MI
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Zip | 48108-3304
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Country | US
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Telephone | 734-585-7086
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Fax |
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Provider Business Mailing Address
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Address Line | 455 E EISENHOWER PKWY STE 30
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City | ANN ARBOR
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State | MI
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Zip | 48108-3304
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Country | US
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Telephone | 734-585-7086
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Fax |
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | MRS. KRISTA GRAVATT
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Credential | LMSW
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Telephone | 734-634-8366
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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