Provider Demographics
NPI:1740725241
Name:FOSTER, DANELLE (MS, LAPC)
Entity type:Individual
Prefix:
First Name:DANELLE
Middle Name:
Last Name:FOSTER
Suffix:
Gender:F
Credentials:MS, LAPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4020 SUGAR VALLEY DR SE
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30094-3822
Mailing Address - Country:US
Mailing Address - Phone:770-922-5201
Mailing Address - Fax:
Practice Address - Street 1:542 PARKWOOD WAY
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236-1326
Practice Address - Country:US
Practice Address - Phone:770-460-0970
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-20
Last Update Date:2016-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC005727101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health