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NPI Code Detail

MEDICARE: LARESHA FOSTER M.A., L.M.S.W., CAMS

MEDICARE: LARESHA FOSTER M.A., L.M.S.W., CAMS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health CounselorMSW006541GA

General Provider Information

NPI Number : 1134586621
Entity Type Code : Individual
Provider Name (Legal Business Name) : LARESHA FOSTER M.A., L.M.S.W., CAMS
Provider Business Mailing Address
First Line : 1100 CLEVELAND AVE
Second Line :
City : EAST POINT
State : GA
Zip : 30344-3602
Country : US
Telephone Number : 404-564-7063
Fax Number :
Provider Business Practice Location Address
First Line : 1100 CLEVELAND AVE
Second Line :
City : EAST POINT
State : GA
Zip : 30344-3602
Country : US
Telephone Number : 404-564-7063
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/28/2016
Last Update Date : 03/14/2016

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