Individual
TINA MARIE GRAVES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW,LCSW,LMFT
Contact information
Practice address
100 TERRI RD, GULFPORT, MS 39503-3336
(228) 832-3362
(888) 241-6012
Mailing address
PO BOX 2276, GULFPORT, MS 39505-2276
(228) 832-3362
(888) 241-6012
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
C5073
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00118808
—
MS
Enumeration date
07/13/2006
Last updated
10/19/2010
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