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General NPI Number Information
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NPI Number | 1114428695
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Entity Type | Organization
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Legal Business Name | FOSTER4LOVE INC.
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Dates
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Enumeration Date | 02/21/2018
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Last Update Date | 05/29/2019
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Provider Practice Location Address
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Address Line | 3745 CHEROKEE ST NW STE 602
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City | KENNESAW
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State | GA
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Zip | 30144-6785
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Country | US
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Telephone | 770-558-5491
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Fax |
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Provider Business Mailing Address
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Address Line | 4393 LAURIAN DR NW
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City | KENNESAW
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State | GA
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Zip | 30144-5147
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Country | US
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Telephone | 770-558-5491
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | JENNIFER COURTNEY MOODY
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Credential |
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Telephone | 770-558-5491
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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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 | 2080P0006X
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Taxonomy Name | Developmental - Behavioral Pediatrics Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QH0700X
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Taxonomy Name | Hearing and Speech Clinic/Center
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 261QX0100X
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Taxonomy Name | Occupational Medicine Clinic/Center
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License Number |
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License Number State |
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