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General NPI Number Information
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NPI Number | 1588793194
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Entity Type | Organization
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Legal Business Name | STEPHEN FOSS LLC
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Dates
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Enumeration Date | 03/02/2007
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Last Update Date | 10/02/2018
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Provider Practice Location Address
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Address Line | 2735 HENNING DR STE A
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City | WINSTON SALEM
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State | NC
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Zip | 27106-4578
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Country | US
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Telephone | 800-388-9804
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Fax | 336-701-6902
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Provider Business Mailing Address
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Address Line | 1959 N PEACE HAVEN RD # 201
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City | WINSTON SALEM
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State | NC
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Zip | 27106-4850
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Country | US
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Telephone | 336-287-3843
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. STEPHEN FOSS
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Credential | LMFT
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Telephone | 336-287-3843
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 821
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License Number State | NC
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