Provider Demographics
NPI:1437955226
Name:PAULA G. GRAVITT, LLC
Entity type:Organization
Organization Name:PAULA G. GRAVITT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PMHNP
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:GAYLE
Authorized Official - Last Name:GRAVITT
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC
Authorized Official - Phone:757-828-5659
Mailing Address - Street 1:1600 WHIPPOORWILL TRCE
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23322-1275
Mailing Address - Country:US
Mailing Address - Phone:804-921-5580
Mailing Address - Fax:
Practice Address - Street 1:555 BELAIRE AVE
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-4783
Practice Address - Country:US
Practice Address - Phone:757-828-5659
Practice Address - Fax:757-992-8583
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-21
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty