Provider Demographics
NPI:1487367926
Name:FOSTER, LANNETTE MICHALLE
Entity type:Individual
Prefix:
First Name:LANNETTE
Middle Name:MICHALLE
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 1:417 LINCOLN AVE APT 305
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93901-2648
Mailing Address - Country:US
Mailing Address - Phone:951-376-8560
Mailing Address - Fax:
Practice Address - Street 1:299 12TH ST STE B
Practice Address - Street 2:
Practice Address - City:MARINA
Practice Address - State:CA
Practice Address - Zip Code:93933-6003
Practice Address - Country:US
Practice Address - Phone:831-883-3030
Practice Address - Fax:831-883-3032
Is Sole Proprietor?:No
Enumeration Date:2022-12-29
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
172V00000X
CARH0009881122101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)