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General NPI Number Information
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NPI Number | 1609150960
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Entity Type | Individual
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Provider Name | ANDREA MICHELLE GRAVES PSY.D.
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Gender | Female
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Dates
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Enumeration Date | 10/05/2011
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Last Update Date | 05/26/2020
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Provider Practice Location Address
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Address Line | 1 QUALITY DR DEPARTMENT OF PSYCHIATRY
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City | VACAVILLE
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State | CA
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Zip | 95688-9494
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Country | US
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Telephone | 707-624-2830
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Fax |
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Provider Business Mailing Address
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Address Line | 200 S FRONTAGE RD STE 320
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City | BURR RIDGE
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State | IL
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Zip | 60527-6953
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Country | US
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Telephone | 630-337-8006
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Fax | 630-581-5984
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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