Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 6401014148 | MI |
NPI | 1003274838 |
---|---|
Provider Name | Vickie Foster |
First Address | Clawson, MI 48017-2110 |
Second Address | Clawson, MI 48017-2110 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/02/2016 |
Last Update Date | 14/03/2016 |