Provider Demographics
NPI:1639742505
Name:SCOTT, RAVEN ALECE (MS, NCC)
Entity Type:Individual
Prefix:MS
First Name:RAVEN
Middle Name:ALECE
Last Name:SCOTT
Suffix:
Gender:F
Credentials:MS, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5005 NORTHLAKE HEIGHTS CIR NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30345-2253
Mailing Address - Country:US
Mailing Address - Phone:256-663-0437
Mailing Address - Fax:
Practice Address - Street 1:50 GLENLAKE PKWY STE 120
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-7270
Practice Address - Country:US
Practice Address - Phone:678-328-4100
Practice Address - Fax:770-671-8508
Is Sole Proprietor?:No
Enumeration Date:2021-07-20
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional