Provider Demographics
NPI:1770997520
Name:FOSTER-DOTSON, SHAQUANNA (MSSA, LCSWC)
Entity type:Individual
Prefix:MRS
First Name:SHAQUANNA
Middle Name:
Last Name:FOSTER-DOTSON
Suffix:
Gender:F
Credentials:MSSA, LCSWC
Other - Prefix:MRS
Other - First Name:SHAQUANNA
Other - Middle Name:
Other - Last Name:FOSTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSSA, LCSW-C
Mailing Address - Street 1:PO BOX 7036
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21216-0036
Mailing Address - Country:US
Mailing Address - Phone:410-258-6714
Mailing Address - Fax:
Practice Address - Street 1:4654 YORK RD STE 1A
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21212-4726
Practice Address - Country:US
Practice Address - Phone:410-258-6714
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-19
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD148791041S0200X, 106H00000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist