Provider Demographics
NPI:1225173404
Name:FOSTER, WENDY BRYANT (LCSW)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:BRYANT
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 1:2001 LASSITER DR
Mailing Address - Street 2:
Mailing Address - City:GOODLETTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37072-8928
Mailing Address - Country:US
Mailing Address - Phone:615-604-5527
Mailing Address - Fax:
Practice Address - Street 1:695 PRESIDENT PL
Practice Address - Street 2:STE 202
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167-5681
Practice Address - Country:US
Practice Address - Phone:615-269-4990
Practice Address - Fax:615-953-9862
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6167101YM0800X
TN4870101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health