Provider Demographics
NPI:1568435485
Name:FOUSEK, BARBARA ANNE (MSW, MED LCSW,ACSW)
Entity Type:Individual
Prefix:MRS
First Name:BARBARA
Middle Name:ANNE
Last Name:FOUSEK
Suffix:
Gender:F
Credentials:MSW, MED LCSW,ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:706 GREEN VALLEY RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-7038
Mailing Address - Country:US
Mailing Address - Phone:336-272-1972
Mailing Address - Fax:336-510-9937
Practice Address - Street 1:706 GREEN VALLEY RD
Practice Address - Street 2:SUITE 100
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-7038
Practice Address - Country:US
Practice Address - Phone:336-272-1972
Practice Address - Fax:336-510-9937
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-10
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0011561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND26-0758808OtherPROVIDER TAX ID
NC6007916Medicaid
NC6007916Medicaid