Provider Demographics
NPI:1053417618
Name:FOSTER, E. VIRGINIA (PHD)
Entity type:Individual
Prefix:DR
First Name:E.
Middle Name:VIRGINIA
Last Name:FOSTER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1417 PARK ROW
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-3711
Mailing Address - Country:US
Mailing Address - Phone:858-699-1351
Mailing Address - Fax:858-551-3824
Practice Address - Street 1:7848 IVANHOE AVE
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-4501
Practice Address - Country:US
Practice Address - Phone:858-699-1353
Practice Address - Fax:858-551-2824
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY8202101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health