Provider Demographics
NPI:1104663509
Name:MOTEN, RAVEN-SYMONE (LCSW)
Entity type:Individual
Prefix:
First Name:RAVEN-SYMONE
Middle Name:
Last Name:MOTEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2947 DAISY LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43204-2204
Mailing Address - Country:US
Mailing Address - Phone:219-702-6094
Mailing Address - Fax:
Practice Address - Street 1:2947 DAISY LN
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43204-2204
Practice Address - Country:US
Practice Address - Phone:219-702-6094
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-11
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34011052A1041C0700X
MI68011172401041C0700X
OHI.24052321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical