Healthcare Provider Details

I. General information

NPI: 1245744796
Provider Name (Legal Business Name): RAVEN INSTITUTE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2017
Last Update Date: 07/20/2023
Certification Date: 07/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2879 15TH ST
HINESVILLE GA
31313-8109
US

IV. Provider business mailing address

2879 15TH ST
HINESVILLE GA
31313-8109
US

V. Phone/Fax

Practice location:
  • Phone: 912-599-4740
  • Fax: 912-599-4740
Mailing address:
  • Phone: 912-599-4740
  • Fax: 912-599-4740

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code405300000X
TaxonomyPrevention Professional
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number
License Number State

VIII. Authorized Official

Name: DR. TROY FOSKEY JR.
Title or Position: EXECUTIVE DIRECTOR
Credential: PHD, ND, FMD
Phone: 912-599-4740