Provider Demographics
NPI: | 1033889415 |
---|---|
Name: | FOXX, RENITA RICHMOND (LCMHC, LCAS, CCS) |
Entity Type: | Individual |
Prefix: | |
First Name: | RENITA |
Middle Name: | RICHMOND |
Last Name: | FOXX |
Suffix: | |
Gender: | F |
Credentials: | LCMHC, LCAS, CCS |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 1240 HUFFMAN MILL RD |
Mailing Address - Street 2: | |
Mailing Address - City: | BURLINGTON |
Mailing Address - State: | NC |
Mailing Address - Zip Code: | 27215-8700 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 336-538-7000 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 1240 HUFFMAN MILL RD |
Practice Address - Street 2: | |
Practice Address - City: | BURLINGTON |
Practice Address - State: | NC |
Practice Address - Zip Code: | 27215-8700 |
Practice Address - Country: | US |
Practice Address - Phone: | 336-538-7000 |
Practice Address - Fax: | |
Is Sole Proprietor?: | No |
Enumeration Date: | 2021-09-16 |
Last Update Date: | 2021-09-16 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NC | 1801 | 101YA0400X |
NC | 9478 | 101YP2500X, 101YM0800X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No | 101YA0400X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No | 101YP2500X | Behavioral Health & Social Service Providers | Counselor | Professional |