Provider Demographics
NPI:1598254146
Name:FLENNER, RAVEN VALLIE (BA)
Entity Type:Individual
Prefix:MS
First Name:RAVEN
Middle Name:VALLIE
Last Name:FLENNER
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:RAVEN
Other - Middle Name:VALLIE
Other - Last Name:WEBSTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:241 GROVE FARM LN
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25404-4995
Mailing Address - Country:US
Mailing Address - Phone:304-283-9302
Mailing Address - Fax:
Practice Address - Street 1:120 BELLVIEW AVE
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-3142
Practice Address - Country:US
Practice Address - Phone:540-542-0200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-08
Last Update Date:2018-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst