Provider Demographics
NPI:1902244031
Name:FOXWORTH, CORPIA DEVONNE
Entity Type:Individual
Prefix:
First Name:CORPIA
Middle Name:DEVONNE
Last Name:FOXWORTH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6551 MCCARRAN ST
Mailing Address - Street 2:APT 2098
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89086-1435
Mailing Address - Country:US
Mailing Address - Phone:702-747-0450
Mailing Address - Fax:
Practice Address - Street 1:600 N 1ST ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89101-1904
Practice Address - Country:US
Practice Address - Phone:702-463-0110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-11
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst