Provider Demographics
NPI:1306522719
Name:RASPPERRY, IMANI (MSW)
Entity type:Individual
Prefix:
First Name:IMANI
Middle Name:
Last Name:RASPPERRY
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:IMANI
Other - Middle Name:
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 311
Mailing Address - Street 2:
Mailing Address - City:BUNNELL
Mailing Address - State:FL
Mailing Address - Zip Code:32110-0311
Mailing Address - Country:US
Mailing Address - Phone:850-524-7732
Mailing Address - Fax:
Practice Address - Street 1:9 PINE CONE DR STE 107
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-8683
Practice Address - Country:US
Practice Address - Phone:850-524-7732
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-22
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health