Provider Demographics
NPI:1699345553
Name:GOSHEN WELLNESS CENTER
Entity type:Organization
Organization Name:GOSHEN WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-514-2385
Mailing Address - Street 1:7105 ABLE RD
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23832-8418
Mailing Address - Country:US
Mailing Address - Phone:804-514-2385
Mailing Address - Fax:
Practice Address - Street 1:12801 IRON BRIDGE RD STE 100
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:VA
Practice Address - Zip Code:23831-1669
Practice Address - Country:US
Practice Address - Phone:804-661-5886
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-01
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health