| Raven Counseling Services, Inc. | |
|
867 Commerce Dr Sw Suite 200-400 Conyers GA 30094-6604 | |
| (770) 679-4043 | |
| (770) 679-4915 |
| Full Name | Raven Counseling Services, Inc. |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 867 Commerce Dr Sw, Conyers, Georgia |
| Authorized Official Name and Position | Cassandra E Conton (CEO) |
| Authorized Official Contact | 7706794043 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Raven Counseling Services, Inc. 867 Commerce Dr Sw Suite 200-400 Conyers GA 30094-6604 Ph: (770) 679-4043 | Raven Counseling Services, Inc. 867 Commerce Dr Sw Suite 200-400 Conyers GA 30094-6604 Ph: (770) 679-4043 |
| NPI Number | 1043593791 |
|---|---|
| Provider Enumeration Date | 09/20/2011 |
| Last Update Date | 03/05/2015 |
| Medicare PECOS PAC ID | 0042481061 |
|---|---|
| Medicare Enrollment ID | O20110923000452 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043593791 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | LPC004669 (Georgia) | Primary |
| Provider Name | Cassandra E Conton |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1932344645 PECOS PAC ID: 3971774894 Enrollment ID: I20110923000577 |
| Provider Name | Lynne Collier |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1093145088 PECOS PAC ID: 6800191263 Enrollment ID: I20160223000365 |
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