Provider Demographics
NPI:1912490640
Name:FOSTER, JAMIE RENEE (LPC)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:RENEE
Last Name:FOSTER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:AR
Mailing Address - Zip Code:72936-7007
Mailing Address - Country:US
Mailing Address - Phone:479-996-8884
Mailing Address - Fax:479-996-8009
Practice Address - Street 1:420 N MAIN ST
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:AR
Practice Address - Zip Code:72936-7007
Practice Address - Country:US
Practice Address - Phone:479-996-8884
Practice Address - Fax:479-996-8009
Is Sole Proprietor?:No
Enumeration Date:2018-06-07
Last Update Date:2018-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP0706028101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional