Provider Demographics
NPI:1003853813
Name:FOX, SANDIE W (LCSW, LCADC)
Entity Type:Individual
Prefix:
First Name:SANDIE
Middle Name:W
Last Name:FOX
Suffix:
Gender:F
Credentials:LCSW, LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 S ARLINGTON AVE
Mailing Address - Street 2:STE 212A
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-1527
Mailing Address - Country:US
Mailing Address - Phone:775-544-5650
Mailing Address - Fax:775-870-1310
Practice Address - Street 1:505 S ARLINGTON AVE
Practice Address - Street 2:STE 212A
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-1527
Practice Address - Country:US
Practice Address - Phone:775-544-5650
Practice Address - Fax:775-870-1310
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-01
Last Update Date:2016-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV 2105C1041C0700X
NVNV00191-LC101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100508118Medicaid
NVGC313AMedicare UPIN
NV100508117Medicaid