Provider Demographics
NPI:1336634906
Name:GO FOSTER INC.
Entity Type:Organization
Organization Name:GO FOSTER INC.
Other - Org Name:COMPASSIONATE COMMUNITY COUNSELING (C3) SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:M
Authorized Official - Last Name:CROOM
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:850-201-7313
Mailing Address - Street 1:113 S MONROE ST
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32301-1529
Mailing Address - Country:US
Mailing Address - Phone:850-201-7313
Mailing Address - Fax:
Practice Address - Street 1:113 S MONROE ST
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32301-1529
Practice Address - Country:US
Practice Address - Phone:850-201-7313
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-26
Last Update Date:2018-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty