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General NPI Number Information
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NPI Number | 1811884604
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Entity Type | Individual
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Provider Name | RAVEN DENISE ANDERSON MS
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Gender | Female
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Dates
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Enumeration Date | 06/23/2025
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Last Update Date | 06/23/2025
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Provider Practice Location Address
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Address Line | 4646 POPLAR AVE STE 325
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City | MEMPHIS
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State | TN
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Zip | 38117-4433
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Country | US
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Telephone | 901-701-8512
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Fax |
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Provider Business Mailing Address
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Address Line | 7408 LOST TRAIL DR
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City | CORDOVA
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State | TN
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Zip | 38016-4982
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Country | US
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Telephone | 901-228-4434
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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