Provider Demographics
NPI:1932501301
Name:FOSTER, LISA (LMHC, CRC)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:
Last Name:FOSTER
Suffix:
Gender:F
Credentials:LMHC, CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10954 CRICHTON RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32221-2870
Mailing Address - Country:US
Mailing Address - Phone:904-383-7392
Mailing Address - Fax:904-783-9966
Practice Address - Street 1:10954 CRICHTON RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32221-2870
Practice Address - Country:US
Practice Address - Phone:904-383-7392
Practice Address - Fax:904-783-9966
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-17
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH11739101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health