Provider Demographics
NPI:1962978825
Name:FOSTER, ANNALIESE PAIGE (LMHC)
Entity type:Individual
Prefix:
First Name:ANNALIESE
Middle Name:PAIGE
Last Name:FOSTER
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4429 SW COUNTY ROAD 344
Mailing Address - Street 2:
Mailing Address - City:BELL
Mailing Address - State:FL
Mailing Address - Zip Code:32619-1781
Mailing Address - Country:US
Mailing Address - Phone:352-890-2182
Mailing Address - Fax:
Practice Address - Street 1:4429 SW COUNTY ROAD 344
Practice Address - Street 2:
Practice Address - City:BELL
Practice Address - State:FL
Practice Address - Zip Code:32619-1781
Practice Address - Country:US
Practice Address - Phone:813-376-9891
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-18
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH22793101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMH22793OtherBOARD OF MENTAL HEALTH