Provider Demographics
NPI:1225148463
Name:FOSTER, PHIL E (MDIV, LPC)
Entity Type:Individual
Prefix:MR
First Name:PHIL
Middle Name:E
Last Name:FOSTER
Suffix:
Gender:M
Credentials:MDIV, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3104 MERCER UNIVERSITY DR
Mailing Address - Street 2:SUITE 220
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30341-4143
Mailing Address - Country:US
Mailing Address - Phone:404-314-8325
Mailing Address - Fax:770-457-9480
Practice Address - Street 1:3104 MERCER UNIVERSITY DR
Practice Address - Street 2:SUITE 220
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30341-4143
Practice Address - Country:US
Practice Address - Phone:404-314-8325
Practice Address - Fax:770-457-9480
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1227101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional