Individual provider Active NPI

Dorothea Foster

  • Professional Counselor
  • Southfield, MI
National Provider Identifier
1063965432
Registry record updated Oct 10, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
6401019634 Issued in MI
Practice address
29623 Northwestern Hwy Ste 6
Southfield, MI 48034-1076
Phone
(313) 932-5527
Fax
(313) 731-1991
NPI assigned
Aug 2, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 10, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Counselor 101Y00000X
Professional Counselor 101YP2500X 6401019634 MI Primary

Addresses

Primary practice location

29623 Northwestern Hwy Ste 6
Southfield, MI 48034-1076

Mailing address

628 Pingree St
Detroit, MI 48202-2024
Phone (313) 932-5527

Other practice location 1

628 Pingree St
Detroit, MI 48202-2024
Phone (313) 932-5527

Other identifiers 2

IdentifierTypeStateIssuer
1063965432MedicaidMI
6401019634OtherMIMENTAL/ BEHAVIORAL HEALTH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240111001536 MI Practitioner - Mental Health Counselor 0244622413 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Real Impact Behavioral Health Center Counselor CurrentSince Feb 1, 2021 Accepting new patients
Real Solutions Services Current Accepting new patients
Real Perspective Counseling Agency Mental Health CurrentSince Oct 21, 2021 Accepting new patients

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1470096000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1665360000000",
    "number": "1063965432",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "628 PINGREE ST",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482022024",
            "telephone_number": "313-932-5527",
            "fax_number": "313-784-9612"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "29623 NORTHWESTERN HWY STE 6",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480341076",
            "telephone_number": "313-932-5527",
            "fax_number": "313-731-1991"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "628 Pingree St",
            "address_purpose": "LOCATION",
            "city": "Detroit",
            "state": "MI",
            "postal_code": "482022024",
            "country_code": "US",
            "telephone_number": "313-932-5527",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FOSTER",
        "first_name": "DOROTHEA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-08-02",
        "last_updated": "2022-10-10",
        "certification_date": "2022-10-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MI",
            "license": "6401019634",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1063965432",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MENTAL/ BEHAVIORAL HEALTH",
            "identifier": "6401019634",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Southfield, MI

Sources for this page

Verify at the official NPI Registry.