Provider Demographics
NPI:1720181753
Name:FOSTER, KEELY ROCHANDALEY (LPC)
Entity Type:Individual
Prefix:MISS
First Name:KEELY
Middle Name:ROCHANDALEY
Last Name:FOSTER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7100 PEACHTREE DUNWOODY RD STE 200
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-1689
Mailing Address - Country:US
Mailing Address - Phone:678-302-1945
Mailing Address - Fax:404-601-1386
Practice Address - Street 1:7100 PEACHTREE DUNWOODY RD STE 200
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-1689
Practice Address - Country:US
Practice Address - Phone:678-302-1945
Practice Address - Fax:404-601-1386
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2638101YM0800X
GALPC2638101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA8820574047AMedicaid