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General NPI Number Information
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NPI Number | 1952811226
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Entity Type | Individual
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Provider Name | LUCIE S GRAVES LCPC, LADC
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Gender | Female
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Dates
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Enumeration Date | 10/02/2017
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Last Update Date | 02/08/2024
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Provider Practice Location Address
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Address Line | 336 MOUNT HOPE AVE STE 14
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City | BANGOR
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State | ME
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Zip | 04401-4236
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Country | US
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Telephone | 207-991-3310
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Fax | 207-573-4666
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Provider Business Mailing Address
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Address Line | 336 MOUNT HOPE AVE STE 14
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City | BANGOR
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State | ME
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Zip | 04401-4236
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Country | US
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Telephone | 207-991-3310
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Fax | 207-543-4666
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | LC7968
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License Number State | ME
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | CC5029
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License Number State | ME
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