Provider Demographics
NPI:1902961220
Name:FOX, EVE (LCMHC)
Entity Type:Individual
Prefix:
First Name:EVE
Middle Name:
Last Name:FOX
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1249 AMES HILL ROAD
Mailing Address - Street 2:
Mailing Address - City:BRATTLEBORO
Mailing Address - State:VT
Mailing Address - Zip Code:05301
Mailing Address - Country:US
Mailing Address - Phone:802-257-0963
Mailing Address - Fax:
Practice Address - Street 1:BRATTLEBORO PASTORAL COUNSELING CENTER
Practice Address - Street 2:190 MAIN STREET
Practice Address - City:BRATTLEBORO
Practice Address - State:VT
Practice Address - Zip Code:05301
Practice Address - Country:US
Practice Address - Phone:802-254-9071
Practice Address - Fax:802-254-9071
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0680000502101Y00000X
MA4255101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1007367Medicaid
MA49550OtherBLUE CROSS BLUE SHIELD
VT49550OtherBLUE CROSS BLUE SHIELD