Provider Demographics
NPI:1912395641
Name:FOSTER, CARROLL WESSON (LCSW)
Entity Type:Individual
Prefix:
First Name:CARROLL
Middle Name:WESSON
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:PO BOX 2344
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30903-2344
Mailing Address - Country:US
Mailing Address - Phone:706-396-1474
Mailing Address - Fax:706-396-1461
Practice Address - Street 1:127 TELFAIR ST
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30901-2590
Practice Address - Country:US
Practice Address - Phone:706-922-0600
Practice Address - Fax:706-396-1461
Is Sole Proprietor?:No
Enumeration Date:2015-01-05
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC125591041C0700X
GACSW0059771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical