Healthcare Provider Details

I. General information

NPI: 1033952478
Provider Name (Legal Business Name): RAVEN K. COKLEY LPC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2024
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1385 HIGHBORNE DR
AUGUSTA GA
30906-7605
US

IV. Provider business mailing address

1385 HIGHBORNE DR
AUGUSTA GA
30906-7605
US

V. Phone/Fax

Practice location:
  • Phone: 941-914-8528
  • Fax:
Mailing address:
  • Phone: 941-914-8528
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: