Provider Demographics
NPI:1225901986
Name:GRAVELY-STRAYHORN, JUSTIN DANTA (LCSW)
Entity type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:DANTA
Last Name:GRAVELY-STRAYHORN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 DUPREE LN
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23324-1475
Mailing Address - Country:US
Mailing Address - Phone:804-299-8710
Mailing Address - Fax:
Practice Address - Street 1:615 DUPREE LN
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23324-1475
Practice Address - Country:US
Practice Address - Phone:804-299-8710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-27
Last Update Date:2025-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490302671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty