Healthcare Provider Details

I. General information

NPI: 1174979371
Provider Name (Legal Business Name): HOLLY ANN FOSTER LMBT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2016
Last Update Date: 05/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 MARTIN AVE
BOONVILLE NC
27011-8166
US

IV. Provider business mailing address

106 MARTIN AVE
BOONVILLE NC
27011-8166
US

V. Phone/Fax

Practice location:
  • Phone: 336-671-3157
  • Fax:
Mailing address:
  • Phone: 336-671-3157
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number01838
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: