Provider Demographics
NPI:1023344629
Name:FOSTER, ORA GWENDOLYN (LCSW)
Entity type:Individual
Prefix:MS
First Name:ORA
Middle Name:GWENDOLYN
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 1:301 14TH ST NW
Mailing Address - Street 2:
Mailing Address - City:FORT PAYNE
Mailing Address - State:AL
Mailing Address - Zip Code:35967-3155
Mailing Address - Country:US
Mailing Address - Phone:256-845-4571
Mailing Address - Fax:256-845-4582
Practice Address - Street 1:301 14TH ST NW
Practice Address - Street 2:
Practice Address - City:FORT PAYNE
Practice Address - State:AL
Practice Address - Zip Code:35967-3155
Practice Address - Country:US
Practice Address - Phone:256-845-4571
Practice Address - Fax:256-845-4582
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-02
Last Update Date:2009-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1509C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical