Provider Demographics
NPI:1073241105
Name:FOSTER, LATWICE (CRC, NCC, LAPC)
Entity Type:Individual
Prefix:
First Name:LATWICE
Middle Name:
Last Name:FOSTER
Suffix:
Gender:F
Credentials:CRC, NCC, LAPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 80112
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30366-0112
Mailing Address - Country:US
Mailing Address - Phone:770-862-4989
Mailing Address - Fax:
Practice Address - Street 1:3069 AMWILER RD STE 10
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30360-2825
Practice Address - Country:US
Practice Address - Phone:470-875-3113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-08
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA008719101Y00000X, 101YP2500X
101YM0800X
GA366134225C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional