Individual
JESSICA FOSTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MHL
Contact information
Practice address
4545 JESSUP GROVE RD, GREENSBORO, NC 27410-9407
(336) 542-0069
Mailing address
1814 SAVANNAS RUN DR, GREENSBORO, NC 27405-1699
(336) 987-4578
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
MHL-041-1210
NC
Other
Enumeration date
03/05/2021
Last updated
02/25/2022
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