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General NPI Number Information
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NPI Number | 1700280633
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Entity Type | Individual
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Provider Name | LYNNE RAVENEL M.S.W, L.I.S.W.
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Gender | Female
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Dates
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Enumeration Date | 10/21/2014
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Last Update Date | 10/21/2014
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Provider Practice Location Address
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Address Line | 1012 ANNA KNAPP EXT
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City | MT PLEASANT
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State | SC
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Zip | 29464-5400
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Country | US
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Telephone | 843-884-3070
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Fax | 843-884-0061
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Provider Business Mailing Address
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Address Line | 1012 ANNA KNAPP EXT
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City | MT PLEASANT
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State | SC
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Zip | 29464-5400
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Country | US
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Telephone | 843-884-3070
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Fax | 843-884-0061
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 2152
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License Number State | SC
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