Provider Demographics
NPI:1548734544
Name:FOSTER, AMBER MONIQUE (LCSW-S)
Entity Type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:MONIQUE
Last Name:FOSTER
Suffix:
Gender:F
Credentials:LCSW-S
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:MONIQUE
Other - Last Name:NEALY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9800 HILLWOOD PKWY STE 140 PMB#22
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76177-1532
Mailing Address - Country:US
Mailing Address - Phone:469-772-0904
Mailing Address - Fax:
Practice Address - Street 1:9800 HILLWOOD PKWY STE 140 PMB#22
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76177-1532
Practice Address - Country:US
Practice Address - Phone:469-772-0904
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-14
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX616011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical