MEDICARE: JESSICA MEGAN FOSTER LPC

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
1	101YP2500X	Professional Counselor	LPC013984	GA

General Provider Information

NPI Number	:	1518640655
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA MEGAN FOSTER LPC

Provider Business Mailing Address
First Line	:	PO BOX 2
Second Line	:
City	:	MC CAYSVILLE
State	:	GA
Zip	:	30555-0002
Country	:	US
Telephone Number	:	706-851-7904
Fax Number	:

Provider Business Practice Location Address
First Line	:	956 BLUE RIDGE DR
Second Line	:
City	:	MC CAYSVILLE
State	:	GA
Zip	:	30555-2504
Country	:	US
Telephone Number	:	706-851-7904
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/07/2023
Last Update Date	:	08/07/2023

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