Provider Demographics
NPI:1326797226
Name:FOX, SHELLY NOELLE (MA)
Entity Type:Individual
Prefix:
First Name:SHELLY
Middle Name:NOELLE
Last Name:FOX
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 975
Mailing Address - Street 2:
Mailing Address - City:FLOYD
Mailing Address - State:VA
Mailing Address - Zip Code:24091-0975
Mailing Address - Country:US
Mailing Address - Phone:540-501-7169
Mailing Address - Fax:540-745-4706
Practice Address - Street 1:401 S LOCUST ST
Practice Address - Street 2:
Practice Address - City:FLOYD
Practice Address - State:VA
Practice Address - Zip Code:24091-2323
Practice Address - Country:US
Practice Address - Phone:540-501-7169
Practice Address - Fax:540-745-4706
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-20
Last Update Date:2022-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0704014663101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health