Provider Demographics
NPI:1154723534
Name:GOAT & SNOWFLAKE, LLC
Entity type:Organization
Organization Name:GOAT & SNOWFLAKE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:STEBLEZ
Authorized Official - Last Name:ASHLEY
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:678-458-7219
Mailing Address - Street 1:3028 BROOKWOOD OAK LN SW
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-8112
Mailing Address - Country:US
Mailing Address - Phone:678-458-7219
Mailing Address - Fax:
Practice Address - Street 1:3028 BROOKWOOD OAK LN SW
Practice Address - Street 2:
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-8112
Practice Address - Country:US
Practice Address - Phone:678-458-7219
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-17
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC007878261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health