Provider Demographics
NPI:1265925481
Name:CLEMENTS, RAVELLE SYMONE
Entity type:Individual
Prefix:
First Name:RAVELLE
Middle Name:SYMONE
Last Name:CLEMENTS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8000 GREENBELT STATION PKWY APT 316
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-4179
Mailing Address - Country:US
Mailing Address - Phone:937-626-9685
Mailing Address - Fax:
Practice Address - Street 1:8000 GREENBELT STATION PKWY APT 316
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-4179
Practice Address - Country:US
Practice Address - Phone:937-626-9685
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-12
Last Update Date:2018-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician