Provider Demographics
NPI:1275347270
Name:RAVEN HEART, LLC
Entity type:Organization
Organization Name:RAVEN HEART, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAXIMILLIAN
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:HAMKE
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC
Authorized Official - Phone:256-203-6558
Mailing Address - Street 1:26 QUEENSLAND DR SW
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35824-4114
Mailing Address - Country:US
Mailing Address - Phone:916-320-9041
Mailing Address - Fax:
Practice Address - Street 1:9694 MADISON BLVD STE A10
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-9137
Practice Address - Country:US
Practice Address - Phone:256-203-6558
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-03
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty