Provider Demographics
NPI:1285049080
Name:GRAVES, DAISHA (MED)
Entity type:Individual
Prefix:MRS
First Name:DAISHA
Middle Name:
Last Name:GRAVES
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 PADDOCK HILL DR
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02347-1233
Mailing Address - Country:US
Mailing Address - Phone:742-186-5307
Mailing Address - Fax:
Practice Address - Street 1:170 PLEASANT ST
Practice Address - Street 2:ROOM 100
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02721-3015
Practice Address - Country:US
Practice Address - Phone:774-294-5722
Practice Address - Fax:774-294-5724
Is Sole Proprietor?:No
Enumeration Date:2014-07-01
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 101YS0200X
MALMHC10003210101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool