Provider Demographics
NPI:1255900601
Name:FOSTER, TAMBRA (LPC)
Entity type:Individual
Prefix:
First Name:TAMBRA
Middle Name:
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 1:200 GENTLE DOE DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-3671
Mailing Address - Country:US
Mailing Address - Phone:478-845-1167
Mailing Address - Fax:
Practice Address - Street 1:200 GENTLE DOE DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-3671
Practice Address - Country:US
Practice Address - Phone:478-845-1167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-21
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional