Healthcare Provider Details

I. General information

NPI: 1124368113
Provider Name (Legal Business Name): JAMES PATRCIK FOSTER LMSW, LCDC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2013
Last Update Date: 03/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8350 MEADOW RD STE 198
DALLAS TX
75231-4272
US

IV. Provider business mailing address

3860 EVERGREEN ST APT 201
IRVING TX
75061-3998
US

V. Phone/Fax

Practice location:
  • Phone: 972-639-4963
  • Fax: 214-234-2401
Mailing address:
  • Phone: 972-639-4963
  • Fax: 214-234-2401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number11919
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number57064
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: