Provider Demographics
NPI:1255807608
Name:RAVE, MONICA DOREEN (MA)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:DOREEN
Last Name:RAVE
Suffix:
Gender:
Credentials:MA
Other - Prefix:
Other - First Name:MONICA
Other - Middle Name:DOREEN
Other - Last Name:JOHNSON-PREVOST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1107 J ST
Mailing Address - Street 2:
Mailing Address - City:CENTRALIA
Mailing Address - State:WA
Mailing Address - Zip Code:98531-3237
Mailing Address - Country:US
Mailing Address - Phone:360-524-1162
Mailing Address - Fax:
Practice Address - Street 1:219 N TOWER AVE # 311
Practice Address - Street 2:
Practice Address - City:CENTRALIA
Practice Address - State:WA
Practice Address - Zip Code:98531-4327
Practice Address - Country:US
Practice Address - Phone:360-524-1162
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-23
Last Update Date:2025-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60888313101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health