Provider Demographics
NPI:1083170484
Name:FOX, COLLEEN M (MA, MPH, PHD, CSAC)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:M
Last Name:FOX
Suffix:
Gender:F
Credentials:MA, MPH, PHD, CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45-845 POOKELA ST
Mailing Address - Street 2:
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-5700
Mailing Address - Country:US
Mailing Address - Phone:808-447-5259
Mailing Address - Fax:
Practice Address - Street 1:45-845 POOKELA ST
Practice Address - Street 2:
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744-5700
Practice Address - Country:US
Practice Address - Phone:808-447-5259
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-11
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
HI979-99101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health