Provider Demographics
NPI:1417713603
Name:JOHNSON, RAVEN (MSW, LCSW-A, LCAS-A)
Entity Type:Individual
Prefix:
First Name:RAVEN
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MSW, LCSW-A, LCAS-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 MERRIMON AVE APT 24B
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28804-3450
Mailing Address - Country:US
Mailing Address - Phone:205-514-5057
Mailing Address - Fax:
Practice Address - Street 1:600 MERRIMON AVE APT 24B
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28804-3450
Practice Address - Country:US
Practice Address - Phone:205-514-5057
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-26
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-29153101YA0400X
NCP019322101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)