Provider Demographics
NPI:1205922960
Name:FOSTER, VICKI A (PHD, LPC, MFT)
Entity type:Individual
Prefix:DR
First Name:VICKI
Middle Name:A
Last Name:FOSTER
Suffix:
Gender:F
Credentials:PHD, LPC, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 298
Mailing Address - Street 2:
Mailing Address - City:CUTTEN
Mailing Address - State:CA
Mailing Address - Zip Code:95534-0298
Mailing Address - Country:US
Mailing Address - Phone:707-798-1445
Mailing Address - Fax:949-863-6185
Practice Address - Street 1:18983 HARTMANN RD STE 23
Practice Address - Street 2:
Practice Address - City:HIDDEN VALLEY LAKE
Practice Address - State:CA
Practice Address - Zip Code:95467-8311
Practice Address - Country:US
Practice Address - Phone:949-863-6185
Practice Address - Fax:949-836-6185
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC46695106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty