Healthcare Provider Details

I. General information

NPI: 1508795394
Provider Name (Legal Business Name): SHILOH CITY OF PEACE FOUNDATION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 LASSITER CT
RADCLIFF KY
40160-9283
US

IV. Provider business mailing address

217 LASSITER CT
RADCLIFF KY
40160-9283
US

V. Phone/Fax

Practice location:
  • Phone: 270-300-1841
  • Fax:
Mailing address:
  • Phone: 270-300-1841
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name: DR. LAQUITA GASKINS
Title or Position: THERAPIST
Credential: LPCA
Phone: 270-300-1841