MEDICARE: KATINA GRAVES ERVIN MA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1427305804
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATINA GRAVES ERVIN MA

Provider Business Mailing Address
First Line	:	9 MILLER POND RD
Second Line	:
City	:	SAVANNAH
State	:	GA
Zip	:	31407-6044
Country	:	US
Telephone Number	:	912-323-4676
Fax Number	:

Provider Business Practice Location Address
First Line	:	9 MILLER POND RD
Second Line	:
City	:	SAVANNAH
State	:	GA
Zip	:	31407-6044
Country	:	US
Telephone Number	:	912-323-4676
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/05/2012
Last Update Date	:	08/05/2012

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