Provider Demographics
NPI:1679622740
Name:FOSTER, CHRISTOPHER CHAD (LCSW)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:CHAD
Last Name:FOSTER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4323 PLANTATION PT
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-7808
Mailing Address - Country:US
Mailing Address - Phone:270-929-0162
Mailing Address - Fax:270-228-0341
Practice Address - Street 1:100 W 3RD ST STE 304
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-4129
Practice Address - Country:US
Practice Address - Phone:270-929-0162
Practice Address - Fax:270-228-0341
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2018-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4387104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY30615058Medicaid
KY3360OtherLICENSE NUMBER