Provider Demographics
NPI:1124050232
Name:FOSTER, LOLETA W (PHD)
Entity type:Individual
Prefix:
First Name:LOLETA
Middle Name:W
Last Name:FOSTER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5114 YADKIN RD
Mailing Address - Street 2:# 120
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28303-3251
Mailing Address - Country:US
Mailing Address - Phone:910-864-5196
Mailing Address - Fax:910-864-1092
Practice Address - Street 1:5114 YADKIN RD
Practice Address - Street 2:# 120
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-3251
Practice Address - Country:US
Practice Address - Phone:910-864-5196
Practice Address - Fax:910-864-1092
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1514103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2823012Medicare PIN