Provider Demographics
NPI:1093486664
Name:FOSTER, VENECIA RASHONDA (LMSW)
Entity type:Individual
Prefix:MRS
First Name:VENECIA
Middle Name:RASHONDA
Last Name:FOSTER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 BRIDGE POINTE CT
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-4461
Mailing Address - Country:US
Mailing Address - Phone:678-920-8928
Mailing Address - Fax:
Practice Address - Street 1:HIGHWAY 64, OLD HIGH SCHOOL ROAD
Practice Address - Street 2:
Practice Address - City:SHIPROCK
Practice Address - State:NM
Practice Address - Zip Code:87420-4461
Practice Address - Country:US
Practice Address - Phone:470-231-8801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-23
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN33010572A104100000X
GAMSW008596104100000X
NMM-119261041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMJ7695Medicaid