Provider Demographics
NPI:1780459966
Name:FOX, NICOLE SUZANNE DOUTHETT (LICSW)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:SUZANNE DOUTHETT
Last Name:FOX
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:S
Other - Last Name:DOUTHETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10452 SILVERDALE WAY NW
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-9460
Mailing Address - Country:US
Mailing Address - Phone:360-307-7300
Mailing Address - Fax:877-777-9902
Practice Address - Street 1:10452 SILVERDALE WAY NW
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-9460
Practice Address - Country:US
Practice Address - Phone:360-307-7300
Practice Address - Fax:877-777-9902
Is Sole Proprietor?:No
Enumeration Date:2023-11-17
Last Update Date:2025-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW605807721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical