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General NPI Number Information
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NPI Number | 1073241105
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Entity Type | Individual
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Provider Name | LATWICE FOSTER CRC, NCC, LAPC
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Gender | Female
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Dates
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Enumeration Date | 08/08/2022
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Last Update Date | 05/22/2023
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Provider Practice Location Address
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Address Line | 3069 AMWILER RD STE 10
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City | ATLANTA
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State | GA
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Zip | 30360-2825
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Country | US
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Telephone | 470-875-3113
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 80112
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City | ATLANTA
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State | GA
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Zip | 30366-0112
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Country | US
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Telephone | 770-862-4989
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 008719
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 008719
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License Number State | GA
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Taxonomy #4
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Taxonomy Code | 225C00000X
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Taxonomy Name | Rehabilitation Counselor
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License Number | 366134
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License Number State | GA
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