MEDICARE: RONICA DENISE FOSTER LCAS

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	1915	NC

General Provider Information

NPI Number	:	1700155223
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RONICA DENISE FOSTER LCAS

Provider Business Mailing Address
First Line	:	7068 DORN CIR
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28212-6407
Country	:	US
Telephone Number	:	704-519-9561
Fax Number	:

Provider Business Practice Location Address
First Line	:	7068 DORN CIR
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28212-6407
Country	:	US
Telephone Number	:	704-519-9561
Fax Number	:

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

Provider Enumeration Date	:	12/29/2011
Last Update Date	:	12/29/2011

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