Provider Demographics
NPI:1962390013
Name:MARTIN, RAVEN CIARA (LMSW)
Entity type:Individual
Prefix:
First Name:RAVEN
Middle Name:CIARA
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 AIR STREAM DR
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29577-9009
Mailing Address - Country:US
Mailing Address - Phone:434-841-5683
Mailing Address - Fax:
Practice Address - Street 1:4181 HIGHWAY 17
Practice Address - Street 2:
Practice Address - City:MURRELLS INLET
Practice Address - State:SC
Practice Address - Zip Code:29576-5019
Practice Address - Country:US
Practice Address - Phone:843-652-6077
Practice Address - Fax:843-652-3602
Is Sole Proprietor?:No
Enumeration Date:2025-06-26
Last Update Date:2025-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC15696104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker