Provider Demographics
NPI:1407344666
Name:FOSTER, ALICE FAYE
Entity Type:Individual
Prefix:MRS
First Name:ALICE
Middle Name:FAYE
Last Name:FOSTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3973 MIRACLES BLVD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201-1543
Mailing Address - Country:US
Mailing Address - Phone:313-673-7979
Mailing Address - Fax:
Practice Address - Street 1:3973 MIRACLES BLVD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-1543
Practice Address - Country:US
Practice Address - Phone:313-673-7979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-24
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical