Provider Demographics
NPI:1174673792
Name:FOSTER, MOYA TIKO (PHD)
Entity Type:Individual
Prefix:DR
First Name:MOYA
Middle Name:TIKO
Last Name:FOSTER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4600 EMPEROR BLVD
Mailing Address - Street 2:STE. 200
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27703-8577
Mailing Address - Country:US
Mailing Address - Phone:919-794-1455
Mailing Address - Fax:919-361-4959
Practice Address - Street 1:4600 EMPEROR BLVD
Practice Address - Street 2:STE. 200
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27703-8577
Practice Address - Country:US
Practice Address - Phone:919-651-8416
Practice Address - Fax:919-651-8672
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2014-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3349103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist