Individual
MISS KWANDA LEE GRAVES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4401 PROVIDENCE LANE, SUITE 121, WINSTON-SALEM, NC 27106
(336) 896-1323
(336) 896-1327
Mailing address
350 TEAL DR, WINSTON SALEM, NC 27127-6812
(336) 918-2381
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1598959660
—
NC
Enumeration date
09/07/2016
Last updated
09/07/2016
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