Provider Demographics
NPI:1326398553
Name:FOSTER, CANDACE B (MED;EDS;LPC)
Entity Type:Individual
Prefix:
First Name:CANDACE
Middle Name:B
Last Name:FOSTER
Suffix:
Gender:F
Credentials:MED;EDS;LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:168 CHANNEL BLUFF AVENUE
Mailing Address - Street 2:
Mailing Address - City:PAWLEYS ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29585
Mailing Address - Country:US
Mailing Address - Phone:843-237-8688
Mailing Address - Fax:
Practice Address - Street 1:168 CHANNEL BLUFF AVE
Practice Address - Street 2:
Practice Address - City:PAWLEYS ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29585-5112
Practice Address - Country:US
Practice Address - Phone:843-237-8688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-14
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1797101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional