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NPI Code Detail

MEDICARE: CARMISHA FOSTER LCPC

MEDICARE: CARMISHA FOSTER LCPC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor180012915IL
2101YM0800XMental Health Counselor178011670IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1178011670OTHERILLICENSE

General Provider Information

NPI Number : 1366952764
Entity Type Code : Individual
Provider Name (Legal Business Name) : CARMISHA FOSTER LCPC
Provider Business Mailing Address
First Line : 3001 S MICHIGAN AVE UNIT 2103
Second Line :
City : CHICAGO
State : IL
Zip : 60616-3164
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1136 S DELANO CT W STE B201
Second Line :
City : CHICAGO
State : IL
Zip : 60605-3734
Country : US
Telephone Number : 630-423-6010
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/11/2017
Last Update Date : 07/21/2020

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Directions to “ CARMISHA FOSTER LCPC” Practice Location

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