Provider Demographics
NPI:1003583741
Name:RAVENELL, SHARONDA PATRICE (LCMHC)
Entity type:Individual
Prefix:
First Name:SHARONDA
Middle Name:PATRICE
Last Name:RAVENELL
Suffix:
Gender:
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2015 AYRSLEY TOWN BLVD STE 202
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28273-4068
Mailing Address - Country:US
Mailing Address - Phone:980-533-0856
Mailing Address - Fax:844-894-6961
Practice Address - Street 1:380 COPPERFIELD BLVD NE
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-2402
Practice Address - Country:US
Practice Address - Phone:843-200-7515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-29
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC16896101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty