Provider Demographics
NPI:1528716586
Name:PATTEN, RAVEN ALEXANDRA (LCSWA)
Entity type:Individual
Prefix:
First Name:RAVEN
Middle Name:ALEXANDRA
Last Name:PATTEN
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1769 MAID MARION LN APT 101
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-0067
Mailing Address - Country:US
Mailing Address - Phone:336-354-6463
Mailing Address - Fax:
Practice Address - Street 1:1769 MAID MARION LN APT 101
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-0067
Practice Address - Country:US
Practice Address - Phone:336-354-6463
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-17
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0173081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical