Provider Demographics
NPI:1811884604
Name:ANDERSON, RAVEN DENISE (MS)
Entity type:Individual
Prefix:
First Name:RAVEN
Middle Name:DENISE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:RAVEN
Other - Middle Name:DENISE
Other - Last Name:HUNTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7408 LOST TRAIL DR
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38016-4982
Mailing Address - Country:US
Mailing Address - Phone:901-228-4434
Mailing Address - Fax:
Practice Address - Street 1:4646 POPLAR AVE STE 325
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38117-4433
Practice Address - Country:US
Practice Address - Phone:901-701-8512
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-23
Last Update Date:2025-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health