Provider Demographics
NPI:1164405197
Name:FOSTER, GRETCHEN W (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:GRETCHEN
Middle Name:W
Last Name:FOSTER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1261 E TRICOUNTY BLVD
Mailing Address - Street 2:
Mailing Address - City:OLIVER SPRINGS
Mailing Address - State:TN
Mailing Address - Zip Code:37840-6218
Mailing Address - Country:US
Mailing Address - Phone:865-435-9413
Mailing Address - Fax:865-435-9413
Practice Address - Street 1:1261 E TRICOUNTY BLVD
Practice Address - Street 2:
Practice Address - City:OLIVER SPRINGS
Practice Address - State:TN
Practice Address - Zip Code:37840-6218
Practice Address - Country:US
Practice Address - Phone:865-435-9413
Practice Address - Fax:865-435-9413
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN000914104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3692673Medicaid
TN3692673Medicaid