Provider Demographics
NPI:1881133130
Name:FOSTER, BOBBY FITZGERALD (CSAC-I)
Entity type:Individual
Prefix:
First Name:BOBBY
Middle Name:FITZGERALD
Last Name:FOSTER
Suffix:
Gender:M
Credentials:CSAC-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 ROSENWALD ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27217-2468
Mailing Address - Country:US
Mailing Address - Phone:336-437-7893
Mailing Address - Fax:336-524-6775
Practice Address - Street 1:530 ROSENWALD ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27217-2468
Practice Address - Country:US
Practice Address - Phone:336-437-7893
Practice Address - Fax:336-524-6775
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-20
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)