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Individual

RAVEN KETURAH ELLIS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LCPC

Contact information

Practice address
3525 RESOURCE DRIVE ROOM C47, RANDALLSTOWN, MD 21133
(410) 655-7655
(410) 655-3941
Mailing address
10400 RIDGELAND ROAD STE 1, COCKEYSVILLE, MD 21030
(410) 628-6120
(410) 628-9825

Taxonomy

Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
LC1921
MD

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
251690
COMPSYCH
01
64558301
CAREFIRST MD
01
R5830050
CAREFIRST EHMSI
Enumeration date
10/02/2006
Last updated
07/08/2007
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