Provider Demographics
NPI:1992926190
Name:SHIVE, RAVINA ANNE (LMFT)
Entity type:Individual
Prefix:MRS
First Name:RAVINA
Middle Name:ANNE
Last Name:SHIVE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7110 LYLE RD
Mailing Address - Street 2:
Mailing Address - City:RICHBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29729-9442
Mailing Address - Country:US
Mailing Address - Phone:803-325-4887
Mailing Address - Fax:
Practice Address - Street 1:2200 E 7TH ST
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-3340
Practice Address - Country:US
Practice Address - Phone:704-376-7180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1176106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist