Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 2868-A | NC |
NPI | 1003176041 |
---|---|
Provider Name | Dr. Tiffany Foster |
First Address | Clearwater, FL 33763-2146 |
Second Address | Clearwater, FL 33763-2146 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2012 |
Last Update Date | 11/10/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
12449225 | CAQH (01) | NC |