Provider Demographics
NPI:1457608747
Name:FOSTER, CORINNE MARIA (LCSW)
Entity type:Individual
Prefix:
First Name:CORINNE
Middle Name:MARIA
Last Name:FOSTER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CORINNE
Other - Middle Name:MARIA
Other - Last Name:REARER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:40 PEARL ST NW STE 341
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-3028
Mailing Address - Country:US
Mailing Address - Phone:847-668-4097
Mailing Address - Fax:
Practice Address - Street 1:40 PEARL ST NW STE 341
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503
Practice Address - Country:US
Practice Address - Phone:847-668-4097
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-06
Last Update Date:2018-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490150931041C0700X
IL244276611041S0200X
MI68011007921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool