Healthcare Provider Details

I. General information

NPI: 1649663154
Provider Name (Legal Business Name): ADRIANE VICTORIA FOSTER M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ADRIANE VICTORIA SPENNER

II. Dates (important events)

Enumeration Date: 03/07/2015
Last Update Date: 08/27/2024
Certification Date: 08/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 MONROE AVE NW
GRAND RAPIDS MI
49503-1455
US

IV. Provider business mailing address

11870 PARKLAND CT NW
GRAND RAPIDS MI
49534-8989
US

V. Phone/Fax

Practice location:
  • Phone: 616-259-7207
  • Fax:
Mailing address:
  • Phone: 616-375-7481
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number6301016003
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: