Provider Demographics
NPI:1710238787
Name:GOSHEN VALLEY FOUNDATION
Entity Type:Organization
Organization Name:GOSHEN VALLEY FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:STACY
Authorized Official - Middle Name:LEANN
Authorized Official - Last Name:SABAKA
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:770-324-1215
Mailing Address - Street 1:387 GOSHEN CHURCH WAY
Mailing Address - Street 2:
Mailing Address - City:WALESKA
Mailing Address - State:GA
Mailing Address - Zip Code:30183-2347
Mailing Address - Country:US
Mailing Address - Phone:770-324-1215
Mailing Address - Fax:770-796-1954
Practice Address - Street 1:230 MARIETTA HWY
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-2327
Practice Address - Country:US
Practice Address - Phone:770-789-3797
Practice Address - Fax:404-937-5580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-01
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health