Provider Demographics
NPI:1740716935
Name:FOSTER, PREVIS
Entity type:Individual
Prefix:
First Name:PREVIS
Middle Name:
Last Name:FOSTER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 SPRING PARK RD
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-6209
Mailing Address - Country:US
Mailing Address - Phone:919-339-0882
Mailing Address - Fax:
Practice Address - Street 1:171 SPRING PARK RD
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-6209
Practice Address - Country:US
Practice Address - Phone:919-339-0882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-07
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health