Provider Demographics
NPI:1447964531
Name:FOSTER, STEPHEN LAROY JR (QMHP, CSAC-E)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:LAROY
Last Name:FOSTER
Suffix:JR
Gender:M
Credentials:QMHP, CSAC-E
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:739 THIMBLE SHOALS BLVD STE 1003
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-3585
Mailing Address - Country:US
Mailing Address - Phone:757-947-5500
Mailing Address - Fax:757-299-8317
Practice Address - Street 1:739 THIMBLE SHOALS BLVD STE 1003
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-3585
Practice Address - Country:US
Practice Address - Phone:757-947-5500
Practice Address - Fax:757-299-8317
Is Sole Proprietor?:No
Enumeration Date:2023-01-12
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA84-4678639Medicaid