Provider Demographics
NPI:1275096448
Name:NORMAN, RAVONDA MYCHELLE
Entity Type:Individual
Prefix:
First Name:RAVONDA
Middle Name:MYCHELLE
Last Name:NORMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1748 BELLMEADE DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70815-5419
Mailing Address - Country:US
Mailing Address - Phone:601-446-2442
Mailing Address - Fax:
Practice Address - Street 1:7932 SUMMA AVE STE 2
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-3736
Practice Address - Country:US
Practice Address - Phone:601-446-2442
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-12
Last Update Date:2019-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst