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General NPI Number Information
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NPI Number | 1043593791
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Entity Type | Organization
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Legal Business Name | RAVEN COUNSELING SERVICES, INC.
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Dates
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Enumeration Date | 09/20/2011
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Last Update Date | 03/05/2015
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Provider Practice Location Address
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Address Line | 867 COMMERCE DR SW SUITE 200-400
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City | CONYERS
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State | GA
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Zip | 30094-6604
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Country | US
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Telephone | 770-679-4043
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Fax | 770-679-4915
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Provider Business Mailing Address
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Address Line | 867 COMMERCE DR SW SUITE 200-400
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City | CONYERS
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State | GA
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Zip | 30094-6604
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Country | US
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Telephone | 770-679-4043
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Fax | 770-679-4915
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Authorized Official
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Title or Position | CEO
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Name | CASSANDRA E CONTON
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Credential | PH.D, LPC
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Telephone | 770-679-4043
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | LPC004669
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License Number State | GA
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