Provider Demographics
NPI:1194246215
Name:FOSTER, DOUGLAS GORDON (LCSW)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:GORDON
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 1:551 WELLINGTON WAY
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95688-3607
Mailing Address - Country:US
Mailing Address - Phone:707-816-2346
Mailing Address - Fax:707-864-2845
Practice Address - Street 1:1360 MISSION ST FL 2
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94103-2647
Practice Address - Country:US
Practice Address - Phone:628-217-7740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-28
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1141111041C0700X
CA84997101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor