Provider Demographics
NPI:1548554603
Name:FOX, FREDRICKA CAROLE (MA, LPC, CGRS)
Entity type:Individual
Prefix:MS
First Name:FREDRICKA
Middle Name:CAROLE
Last Name:FOX
Suffix:
Gender:F
Credentials:MA, LPC, CGRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 WHIPPOORWILL LN
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48309-3485
Mailing Address - Country:US
Mailing Address - Phone:586-215-0411
Mailing Address - Fax:
Practice Address - Street 1:2710 S ROCHESTER RD
Practice Address - Street 2:STE A
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-4598
Practice Address - Country:US
Practice Address - Phone:248-260-4258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-07
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401009314101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional