Individual
KENNETH ALONZO GRAVES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CSAC
Contact information
Practice address
2908 NIVRAM RD, PETERSBURG, VA 23805-2637
(804) 590-8295
Mailing address
2908 NIVRAM RD, PETERSBURG, VA 23805-2637
(804) 590-8295
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
0710102565
VA
Other
Enumeration date
11/27/2024
Last updated
11/27/2024
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