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General NPI Number Information
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NPI Number | 1407387665
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Entity Type | Individual
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Provider Name | RAVEN LITTLEJOHN-KERSTENS LCSW
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Gender | Female
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Dates
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Enumeration Date | 03/21/2017
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Last Update Date | 03/29/2024
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Provider Practice Location Address
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Address Line | 300 PEACHTREE ST NE STE CS2
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City | ATLANTA
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State | GA
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Zip | 30308-3565
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Country | US
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Telephone | 865-630-9062
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Fax |
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Provider Business Mailing Address
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Address Line | 2428 DICKEY RD
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City | AUGUSTA
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State | GA
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Zip | 30906-2671
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Country | US
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Telephone | 865-630-9062
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | MSW007401
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CSW007373
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License Number State | GA
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