Provider Demographics
NPI:1871489278
Name:OFFUTT, RAE'VEN NICOLE
Entity type:Individual
Prefix:
First Name:RAE'VEN
Middle Name:NICOLE
Last Name:OFFUTT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4701 LAKE HAVEN DR
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37416-2208
Mailing Address - Country:US
Mailing Address - Phone:615-734-7516
Mailing Address - Fax:
Practice Address - Street 1:7480 ZIEGLER RD STE 100
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-4943
Practice Address - Country:US
Practice Address - Phone:682-503-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-13
Last Update Date:2025-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN93231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical