Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 6401015391 | MI |
NPI | 1003357641 |
---|---|
Provider Name | Dylan Jay Foster |
First Address | West Bloomfield, MI 48322-4535 |
Second Address | West Bloomfield, MI 48322-4535 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/03/2017 |
Last Update Date | 15/03/2017 |