Provider Demographics
NPI:1356013114
Name:FOSTER, HALIE MARIE (RBT)
Entity Type:Individual
Prefix:
First Name:HALIE
Middle Name:MARIE
Last Name:FOSTER
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 N GROSS RD APT 5C
Mailing Address - Street 2:
Mailing Address - City:KINGSLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31548-6235
Mailing Address - Country:US
Mailing Address - Phone:912-464-4812
Mailing Address - Fax:
Practice Address - Street 1:13121 ATLANTIC BLVD STE 200
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32225-0102
Practice Address - Country:US
Practice Address - Phone:904-491-2111
Practice Address - Fax:904-512-0613
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-30
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-21-186077106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician