Individual
RAVEN VEGA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APC, NCC
Contact information
Practice address
1708 PEACHTREE ST NW STE 425, ATLANTA, GA 30309-7020
(404) 565-4385
Mailing address
2500 SHALLOWFORD RD NE APT 4323, ATLANTA, GA 30345-1225
(732) 379-1825
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
APC008017
GA
106S00000X
Behavior Technician
—
—
Other
Enumeration date
02/05/2018
Last updated
07/14/2021
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