Provider Demographics
NPI:1841845500
Name:FOSTER, RAELYNN ILA IRENE
Entity type:Individual
Prefix:
First Name:RAELYNN
Middle Name:ILA IRENE
Last Name:FOSTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 STINSON ST APT 8
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94591-6416
Mailing Address - Country:US
Mailing Address - Phone:360-346-6581
Mailing Address - Fax:
Practice Address - Street 1:401 STINSON ST APT 8
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94591-6416
Practice Address - Country:US
Practice Address - Phone:360-346-6581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-08
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)