Provider Demographics
NPI:1750951794
Name:FOSTER, EMILY GRISCOM (SW18303)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:GRISCOM
Last Name:FOSTER
Suffix:
Gender:F
Credentials:SW18303
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 LEANNI WAY UNIT C4
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32137-4755
Mailing Address - Country:US
Mailing Address - Phone:386-445-9682
Mailing Address - Fax:
Practice Address - Street 1:50 LEANNI WAY UNIT C4
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-4755
Practice Address - Country:US
Practice Address - Phone:386-445-9682
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-01
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMCAP100640101YA0400X
FLSW183031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)