Provider Demographics
NPI:1174142574
Name:FOSTER, BILLY (LCSW, NCC AP MAC)
Entity type:Individual
Prefix:MR
First Name:BILLY
Middle Name:
Last Name:FOSTER
Suffix:
Gender:M
Credentials:LCSW, NCC AP MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 ALFRED DR
Mailing Address - Street 2:
Mailing Address - City:VICKSBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39180-9147
Mailing Address - Country:US
Mailing Address - Phone:601-415-9424
Mailing Address - Fax:
Practice Address - Street 1:109 ALFRED DR
Practice Address - Street 2:
Practice Address - City:VICKSBURG
Practice Address - State:MS
Practice Address - Zip Code:39180-9147
Practice Address - Country:US
Practice Address - Phone:601-415-9424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-15
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSC62031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical