Healthcare Provider Details

I. General information

NPI: 1912300666
Provider Name (Legal Business Name): KELLY CHARICE FOSTER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KELLY DRAYTON LPC

II. Dates (important events)

Enumeration Date: 10/08/2014
Last Update Date: 03/15/2021
Certification Date: 03/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6276 JACKSON RD STE D
ANN ARBOR MI
48103-9579
US

IV. Provider business mailing address

24623 CHARLES DR
BROWNSTOWN MI
48183-5463
US

V. Phone/Fax

Practice location:
  • Phone: 734-956-0051
  • Fax: 888-976-6019
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401019071
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: