Organization
RAVEN ROCK WELLNESS CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DANA CONN LCSW (MEMBER)
(606) 775-0515
Entity
Organization
Contact information
Practice address
221 HALLS RD, STANTON, KY 40380-2027
(606) 775-0515
(606) 552-0964
Mailing address
221 HALLS RD, STANTON, KY 40380-2027
(606) 775-0515
(606) 552-0964
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Enumeration date
01/20/2023
Last updated
01/20/2023
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