Provider Demographics
NPI:1245744796
Name:RAVEN INSTITUTE, INC.
Entity Type:Organization
Organization Name:RAVEN INSTITUTE, INC.
Other - Org Name:THE RAVEN INSTITUTE INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TROY
Authorized Official - Middle Name:
Authorized Official - Last Name:FOSKEY
Authorized Official - Suffix:JR
Authorized Official - Credentials:PHD, ND, FMD
Authorized Official - Phone:912-599-4740
Mailing Address - Street 1:2879 15TH ST
Mailing Address - Street 2:
Mailing Address - City:HINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31313-8109
Mailing Address - Country:US
Mailing Address - Phone:912-599-4740
Mailing Address - Fax:912-599-4740
Practice Address - Street 1:2879 15TH ST
Practice Address - Street 2:
Practice Address - City:HINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:31313-8109
Practice Address - Country:US
Practice Address - Phone:912-599-4740
Practice Address - Fax:912-599-4740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-20
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X, 102L00000X, 405300000X
GA101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalystGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Multi-Specialty
No405300000XOther Service ProvidersPrevention ProfessionalGroup - Multi-Specialty