Provider Demographics
NPI:1467842856
Name:CRAVENER, GISSELL (BA)
Entity Type:Individual
Prefix:
First Name:GISSELL
Middle Name:
Last Name:CRAVENER
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 39
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29151
Mailing Address - Country:US
Mailing Address - Phone:803-775-6815
Mailing Address - Fax:
Practice Address - Street 1:115 NORTH HARVIN STREET
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29151-0039
Practice Address - Country:US
Practice Address - Phone:803-775-6815
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-23
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)