Individual
RAVEN THOMAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
28303 DEQUINDRE RD STE 100, MADISON HEIGHTS, MI 48071-3040
(248) 658-1116
(248) 658-1120
Mailing address
12546 PROMENADE ST, DETROIT, MI 48213-1416
(313) 624-7712
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
06/23/2021
Last updated
06/23/2021
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