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General NPI Number Information
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NPI Number | 1578867982
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Entity Type | Organization
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Legal Business Name | RAVENS NEST FOUNDATION INC
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Dates
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Enumeration Date | 12/28/2010
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Last Update Date | 12/31/2025
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Provider Practice Location Address
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Address Line | 1680 MULKEY RD STE 200
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City | AUSTELL
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State | GA
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Zip | 30106-1364
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Country | US
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Telephone | 770-819-6825
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Fax | 770-819-6826
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Provider Business Mailing Address
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Address Line | 1680 MULKEY RD STE 200
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City | AUSTELL
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State | GA
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Zip | 30106-1364
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Country | US
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Telephone | 770-819-6825
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Fax | 770-819-6826
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Authorized Official
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Title or Position | CEO
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Name | MS. SHELBY GREEN
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Credential |
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Telephone | 770-819-6825
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 171W00000X
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Taxonomy Name | Contractor
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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