Healthcare Provider Details

I. General information

NPI: 1184895294
Provider Name (Legal Business Name): DANA BLANTON FOSTER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2008
Last Update Date: 06/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 RAY KENNEDY DR SUITE 240
LOCUST NC
28097-8000
US

IV. Provider business mailing address

150 RAY KENNEDY DR STE 240 P.O. BOX 487
LOCUST NC
28097-8000
US

V. Phone/Fax

Practice location:
  • Phone: 704-888-1616
  • Fax: 704-888-1670
Mailing address:
  • Phone: 704-888-1616
  • Fax: 704-888-1670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6906
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: