Provider Demographics
NPI:1700280633
Name:RAVENEL, LYNNE (MSW, LISW)
Entity Type:Individual
Prefix:
First Name:LYNNE
Middle Name:
Last Name:RAVENEL
Suffix:
Gender:F
Credentials:MSW, LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1012 ANNA KNAPP EXT
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-5400
Mailing Address - Country:US
Mailing Address - Phone:843-884-3070
Mailing Address - Fax:843-884-0061
Practice Address - Street 1:1012 ANNA KNAPP EXT
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-5400
Practice Address - Country:US
Practice Address - Phone:843-884-3070
Practice Address - Fax:843-884-0061
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-21
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC21521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical