Provider Demographics
NPI:1124368113
Name:FOSTER, JAMES PATRCIK (LMSW, LCDC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:PATRCIK
Last Name:FOSTER
Suffix:
Gender:M
Credentials:LMSW, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3860 EVERGREEN ST APT 201
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75061-3998
Mailing Address - Country:US
Mailing Address - Phone:972-639-4963
Mailing Address - Fax:214-234-2401
Practice Address - Street 1:8350 MEADOW RD STE 198
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4272
Practice Address - Country:US
Practice Address - Phone:972-639-4963
Practice Address - Fax:214-234-2401
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-27
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11919101YA0400X
TX57064104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)