Healthcare Provider Details

I. General information

NPI: 1275455016
Provider Name (Legal Business Name): RAVEN BRENAY GUNN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2026
Last Update Date: 07/25/2026
Certification Date: 07/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7504 E INDEPENDENCE BLVD STE 103
CHARLOTTE NC
28227-9407
US

IV. Provider business mailing address

6800 WINDING CEDAR TRL APT 102
CHARLOTTE NC
28212-8105
US

V. Phone/Fax

Practice location:
  • Phone: 888-392-8642
  • Fax:
Mailing address:
  • Phone: 206-550-2026
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: