1669695334 NPI number — MR. HAROLD M GRAVES III LCSW-C

Table of content: MR. HAROLD M GRAVES III LCSW-C (NPI 1669695334)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669695334 NPI number — MR. HAROLD M GRAVES III LCSW-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GRAVES
Provider First Name:
HAROLD
Provider Middle Name:
M
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
III
Provider Credential Text:
LCSW-C
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1669695334
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
23524 ROLLING FORK WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GAITHERSBURG
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20882-2838
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
443-397-7767
Provider Business Mailing Address Fax Number:
410-334-6960

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
604 S. FREDERICK ROAD
Provider Second Line Business Practice Location Address:
#213
Provider Business Practice Location Address City Name:
GAITHERSBURG
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20877-1282
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-424-3480
Provider Business Practice Location Address Fax Number:
410-334-6960
Provider Enumeration Date:
04/11/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: MD10165 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 522156095 . This is a "UNITED BEHAVIORAL HEALTH" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 522156095 . This is a "APS HEALTHCARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 609550001 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 517251 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 522156095 . This is a "UNICARE/NCPPO" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: LM49EA . This is a "CAREFIRST BCBS LOCAL" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: R968 . This is a "CAREFIRST BCBS FEDERAL" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 609550004 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 208506201 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 774800100 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 522156095 . This is a "MHNET BEHAVIORAL HEALTH" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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