Healthcare Provider Details
I. General information
NPI: 1518416700
Provider Name (Legal Business Name): RAVEN PRINCE
Entity Type: Individual
Gender: Female
Sole Proprietor: N
II. Dates (important events)
Enumeration Date: 09/28/2016
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:
III. Provider practice location address
PO BOX 224
MILTON LA
70558-0224
US
IV. Provider business mailing address
208 GABLE CREST DR
LAFAYETTE LA
70508-7648
US
V. Phone/Fax
- Phone: 337-366-1606
- Fax:
- Phone: 337-371-9002
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 1041C0700X |
| Taxonomy | Clinical Social Worker |
| License Number | CSW.09928117 |
| License Number State | CO |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 1041C0700X |
| Taxonomy | Clinical Social Worker |
| License Number | L14936 |
| License Number State | OR |
| # 3 | |
| Primary Taxonomy | N |
| Taxonomy Code | 1041C0700X |
| Taxonomy | Clinical Social Worker |
| License Number | 12394-C |
| License Number State | NV |
| # 4 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 1041C0700X |
| Taxonomy | Clinical Social Worker |
| License Number | 11795 |
| License Number State | LA |
| # 5 | |
| Primary Taxonomy | N |
| Taxonomy Code | 1041C0700X |
| Taxonomy | Clinical Social Worker |
| License Number | 60813 |
| License Number State | TX |
| # 6 | |
| Primary Taxonomy | N |
| Taxonomy Code | 1041C0700X |
| Taxonomy | Clinical Social Worker |
| License Number | 0904014135 |
| License Number State | VA |
| # 7 | |
| Primary Taxonomy | N |
| Taxonomy Code | 1041C0700X |
| Taxonomy | Clinical Social Worker |
| License Number | 44SC06529900 |
| License Number State | NJ |
| # 8 | |
| Primary Taxonomy | N |
| Taxonomy Code | 1041C0700X |
| Taxonomy | Clinical Social Worker |
| License Number | LW61528132 |
| License Number State | WA |
| # 9 | |
| Primary Taxonomy | N |
| Taxonomy Code | 1041C0700X |
| Taxonomy | Clinical Social Worker |
| License Number | LICSW1140116 |
| License Number State | MA |
| # 10 | |
| Primary Taxonomy | N |
| Taxonomy Code | 1041C0700X |
| Taxonomy | Clinical Social Worker |
| License Number | 256942 |
| License Number State | KY |
| # 11 | |
| Primary Taxonomy | N |
| Taxonomy Code | 1041C0700X |
| Taxonomy | Clinical Social Worker |
| License Number | LCSW-5467-0 |
| License Number State | HI |
| # 12 | |
| Primary Taxonomy | N |
| Taxonomy Code | 1041C0700X |
| Taxonomy | Clinical Social Worker |
| License Number | CSW005810 |
| License Number State | GA |
| # 13 | |
| Primary Taxonomy | N |
| Taxonomy Code | 1041C0700X |
| Taxonomy | Clinical Social Worker |
| License Number | 101985 |
| License Number State | CA |
| # 14 | |
| Primary Taxonomy | N |
| Taxonomy Code | 1041C0700X |
| Taxonomy | Clinical Social Worker |
| License Number | LCSW14213435-3501 |
| License Number State | UT |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone:
