Provider Demographics
NPI:1497331912
Name:FOSTER, SALLIE EVADNA NICHELLE (MMFT)
Entity Type:Individual
Prefix:
First Name:SALLIE
Middle Name:EVADNA NICHELLE
Last Name:FOSTER
Suffix:
Gender:F
Credentials:MMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 330273
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-7502
Mailing Address - Country:US
Mailing Address - Phone:615-378-7075
Mailing Address - Fax:
Practice Address - Street 1:2612 BUCHANAN ST
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37208-1942
Practice Address - Country:US
Practice Address - Phone:615-378-7075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-23
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN101YA0400X, 106H00000X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health