MEDICARE: LYNN GARLOCK GRAVES LPC

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	101YP2500X	Professional Counselor	2652	SC

General Provider Information

NPI Number	:	1497999494
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYNN GARLOCK GRAVES LPC

Provider Business Mailing Address
First Line	:	984 THREE TREES RD
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29412-4924
Country	:	US
Telephone Number	:	843-795-5679
Fax Number	:	843-795-8290

Provider Business Practice Location Address
First Line	:	1242 PAULINE AVE
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29412-4030
Country	:	US
Telephone Number	:	843-795-0238
Fax Number	:	843-795-8290

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

Provider Enumeration Date	:	04/22/2009
Last Update Date	:	04/22/2009

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