Provider Demographics
NPI:1164864054
Name:WALRAVEN, MICHELLE LOIS (LCSW)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LOIS
Last Name:WALRAVEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2553 CHATSWORTH HWY 225 NE
Mailing Address - Street 2:
Mailing Address - City:CALHOUN
Mailing Address - State:GA
Mailing Address - Zip Code:30701-8404
Mailing Address - Country:US
Mailing Address - Phone:706-483-2606
Mailing Address - Fax:
Practice Address - Street 1:2553 CHATSWORTH HWY 225 NE
Practice Address - Street 2:
Practice Address - City:CALHOUN
Practice Address - State:GA
Practice Address - Zip Code:30701-8404
Practice Address - Country:US
Practice Address - Phone:706-483-2606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-22
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CSW0067551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical