Provider Demographics
NPI:1407387665
Name:LITTLEJOHN-KERSTENS, RAVEN (LCSW)
Entity Type:Individual
Prefix:
First Name:RAVEN
Middle Name:
Last Name:LITTLEJOHN-KERSTENS
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 1:2428 DICKEY RD
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30906-2671
Mailing Address - Country:US
Mailing Address - Phone:865-630-9062
Mailing Address - Fax:
Practice Address - Street 1:300 PEACHTREE ST NE STE CS2
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308-3565
Practice Address - Country:US
Practice Address - Phone:865-630-9062
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-21
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMSW007401101YP2500X
GACSW0073731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional