Kwanda Lee Graves

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

Practice address

4401 Providence Lane
Suite 121
Winston-Salem, NC 27106

Phone

(336) 896-1323

Fax

(336) 896-1327

NPI assigned

Sep 7, 2016

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1473206400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1473206400000",
    "number": "1508313628",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "350 TEAL DR",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271276812",
            "telephone_number": "336-918-2381"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4401 PROVIDENCE LANE",
            "address_2": "SUITE 121",
            "city": "WINSTON-SALEM",
            "state": "NC",
            "postal_code": "27106",
            "telephone_number": "336-896-1323",
            "fax_number": "336-896-1327"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRAVES",
        "first_name": "KWANDA",
        "middle_name": "LEE",
        "name_prefix": "Miss",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-09-07",
        "last_updated": "2016-09-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1598959660",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Roger Edmund Gravel, D.D.S.
• Gevonna Ardell Graves-Worney, LCASA
• Benjamin Graves, M.D.
• Darby E Graves, RD
• Jennifer J Graves, M.D.
• Rachel Lynn Graves, MD
• Gray Chiropractic and Sports Associates, P.a.
• Latonya Shari Gray, DNP, PMHNP-BC
• Lawrence Dennis Gray Jr., D.C.
• Samuel Bemiss Gray, PSY.D

• All providers in Winston-Salem, NC
• Addiction (Substance Use Disorder) Counselor in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.