Provider Demographics
NPI:1780162149
Name:FOX, SAMANTHA JO (LCSWA)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:JO
Last Name:FOX
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7604 GREEN LEVEL CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27523-9438
Mailing Address - Country:US
Mailing Address - Phone:919-602-0324
Mailing Address - Fax:
Practice Address - Street 1:8376 SIX FORKS RD STE 104
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-5095
Practice Address - Country:US
Practice Address - Phone:919-900-7438
Practice Address - Fax:919-900-7576
Is Sole Proprietor?:No
Enumeration Date:2018-07-29
Last Update Date:2018-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCPO127751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical