Healthcare Provider Details

I. General information

NPI: 1700544756
Provider Name (Legal Business Name): TRACIE MICHELLE FOSTER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/07/2021
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 GARNER RD
RALEIGH NC
27610-0114
US

IV. Provider business mailing address

5522 ROBBINS DR
RALEIGH NC
27610-1593
US

V. Phone/Fax

Practice location:
  • Phone: 919-787-6131
  • Fax: 919-571-2932
Mailing address:
  • Phone: 347-803-8273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number18223
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLCAS-27512
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: