Provider Demographics
NPI:1982332052
Name:PAGE, FOSTER (LAC)
Entity Type:Individual
Prefix:
First Name:FOSTER
Middle Name:
Last Name:PAGE
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1672 SOUTH 48TH STREET
Mailing Address - Street 2:SUITE B
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72762
Mailing Address - Country:US
Mailing Address - Phone:479-202-6300
Mailing Address - Fax:479-202-6300
Practice Address - Street 1:5507 W WALSH LN STE 201
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-8995
Practice Address - Country:US
Practice Address - Phone:479-595-0333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-08
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA2204016101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional