Provider Demographics
NPI:1588793194
Name:STEPHEN FOSS LLC
Entity type:Organization
Organization Name:STEPHEN FOSS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:FOSS
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:336-287-3843
Mailing Address - Street 1:1959 N PEACE HAVEN RD # 201
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-4850
Mailing Address - Country:US
Mailing Address - Phone:336-287-3843
Mailing Address - Fax:
Practice Address - Street 1:2735 HENNING DR STE A
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-4578
Practice Address - Country:US
Practice Address - Phone:800-388-9804
Practice Address - Fax:336-701-6902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2018-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC821106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty