MEDICARE: RAVEN MARIE RANSOM MS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	A18099	NC

General Provider Information

NPI Number	:	1053034322
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAVEN MARIE RANSOM MS

Provider Business Mailing Address
First Line	:	10310 SUGARBERRY CT APT 405
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27614-6478
Country	:	US
Telephone Number	:	717-856-1650
Fax Number	:

Provider Business Practice Location Address
First Line	:	140 WIND CHIME CT STE B
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27615-6580
Country	:	US
Telephone Number	:	919-705-0679
Fax Number	:	919-551-7527

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/22/2022
Last Update Date	:	04/07/2025

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