Provider Demographics
NPI:1992994230
Name:FOSTER, AUTUMN LYNN (BS)
Entity type:Individual
Prefix:MS
First Name:AUTUMN
Middle Name:LYNN
Last Name:FOSTER
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:AUTUMN
Other - Middle Name:LYNN
Other - Last Name:FOSTER
Other - Suffix:IX
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:8626 LOWER SACRAMENTO RD
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95210-1835
Mailing Address - Country:US
Mailing Address - Phone:209-478-2487
Mailing Address - Fax:209-478-1476
Practice Address - Street 1:8626 LOWER SACRAMENTO RD
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95210-1835
Practice Address - Country:US
Practice Address - Phone:209-478-2487
Practice Address - Fax:209-478-1476
Is Sole Proprietor?:No
Enumeration Date:2007-10-23
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)