Provider Demographics
NPI:1073381554
Name:FOX, MICHELLE (LPC-A)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:
Last Name:FOX
Suffix:
Gender:F
Credentials:LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 S DARGAN ST
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29506-2549
Mailing Address - Country:US
Mailing Address - Phone:843-407-5419
Mailing Address - Fax:843-407-7274
Practice Address - Street 1:525 S DARGAN ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29506-2549
Practice Address - Country:US
Practice Address - Phone:843-407-5419
Practice Address - Fax:843-407-7274
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-14
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7763101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional