Provider Demographics
NPI:1295304459
Name:DAVIS, RAYVEN BRAYONNA (LLMSW)
Entity type:Individual
Prefix:
First Name:RAYVEN
Middle Name:BRAYONNA
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:RAYVEN
Other - Middle Name:BRAYONNA
Other - Last Name:FULLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14095 SHADYWOOD DR APT 157
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-3161
Mailing Address - Country:US
Mailing Address - Phone:313-330-7085
Mailing Address - Fax:
Practice Address - Street 1:21700 NORTHWESTERN HWY
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-4906
Practice Address - Country:US
Practice Address - Phone:855-445-4554
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-22
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker