Provider Demographics
NPI:1033952478
Name:COKLEY, RAVEN K (APC, NCC)
Entity type:Individual
Prefix:DR
First Name:RAVEN
Middle Name:K
Last Name:COKLEY
Suffix:
Gender:F
Credentials:APC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3445 N DRUID HILLS RD APT C
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-3763
Mailing Address - Country:US
Mailing Address - Phone:941-914-8528
Mailing Address - Fax:
Practice Address - Street 1:3445 N DRUID HILLS RD APT C
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-3763
Practice Address - Country:US
Practice Address - Phone:941-914-8528
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-14
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional