Healthcare Provider Details

I. General information

NPI: 1164405197
Provider Name (Legal Business Name): GRETCHEN W FOSTER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/23/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1261 E TRICOUNTY BLVD
OLIVER SPRINGS TN
37840-6218
US

IV. Provider business mailing address

1261 E TRICOUNTY BLVD
OLIVER SPRINGS TN
37840-6218
US

V. Phone/Fax

Practice location:
  • Phone: 865-435-9413
  • Fax: 865-435-9413
Mailing address:
  • Phone: 865-435-9413
  • Fax: 865-435-9413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number000914
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: