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General NPI Number Information
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NPI Number | 1780402198
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Entity Type | Organization
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Legal Business Name | RAVEN THERAPEUTIC SERVICES, PLLC
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Dates
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Enumeration Date | 10/03/2024
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Last Update Date | 04/11/2025
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Provider Practice Location Address
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Address Line | 2444 COMMERCE RD STE 120
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City | JACKSONVILLE
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State | NC
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Zip | 28546-7561
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Country | US
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Telephone | 910-787-1688
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Fax | 910-338-3135
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Provider Business Mailing Address
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Address Line | 2444 COMMERCE RD STE 120
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City | JACKSONVILLE
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State | NC
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Zip | 28546-7561
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Country | US
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Telephone | 910-787-1688
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Fax | 910-338-3135
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Authorized Official
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Title or Position | OWNER, THERAPIST
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Name | ASHLEY GARNETT
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Credential |
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Telephone | 910-787-1688
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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