Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | ||
N | 101YM0800X | Mental Health Counselor | ||
N | 101YP1600X | Pastoral Counselor | ||
N | 102L00000X | Psychologist | ||
N | 103T00000X | Psychologist | ||
Y | 174N00000X | Lactation Consultant |
NPI | 1275870172 |
---|---|
Provider Name | Prof. Jennifer Michelle Foster |
First Address | Canton, GA 30115-2918 |
Second Address | Canton, GA 30115-2918 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/01/2013 |
Last Update Date | 02/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
26-3017550 | 1275870172 (01) | FL |
A536433835890 | FLORIDA DRIVER'S LICENSE (01) | FL |