Individual
RAVEN JACINDA WALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CADC UNDER SUPERVISI
Contact information
Practice address
2920 CHAUTAUQUA AVE APT 38, NORMAN, OK 73072-7736
(405) 528-8686
(405) 528-8692
Mailing address
2920 CHAUTAUQUA AVE APT 38, NORMAN, OK 73072-7736
(405) 528-8686
(405) 528-8692
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
OK
Other
Enumeration date
04/03/2008
Last updated
04/03/2008
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