Provider Demographics
NPI:1891702650
Name:FOSTER, VIRGINIA P (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:P
Last Name:FOSTER
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:JINNY
Other - Middle Name:
Other - Last Name:FOSTER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW, LCSW
Mailing Address - Street 1:206 N RANDOLPH ST
Mailing Address - Street 2:STE. 526
Mailing Address - City:CHAMPAIGN,
Mailing Address - State:IL
Mailing Address - Zip Code:61820-3949
Mailing Address - Country:US
Mailing Address - Phone:217-356-2322
Mailing Address - Fax:
Practice Address - Street 1:206 N RANDOLPH ST
Practice Address - Street 2:STE. 526
Practice Address - City:CHAMPAIGN,
Practice Address - State:IL
Practice Address - Zip Code:61820-3949
Practice Address - Country:US
Practice Address - Phone:217-356-2322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01072030OtherBLUE CROSS/BLUE SHIELD