Provider Demographics
NPI:1679997829
Name:RAVAN, JOSEPH W JR (LPC)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:W
Last Name:RAVAN
Suffix:JR
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405A E 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:EASLEY
Mailing Address - State:SC
Mailing Address - Zip Code:29640-3062
Mailing Address - Country:US
Mailing Address - Phone:864-437-3703
Mailing Address - Fax:
Practice Address - Street 1:405A E 1ST AVE
Practice Address - Street 2:
Practice Address - City:EASLEY
Practice Address - State:SC
Practice Address - Zip Code:29640-3062
Practice Address - Country:US
Practice Address - Phone:864-644-8251
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-08
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCRCP4566227900000X
SC6278101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered