Provider Demographics
NPI:1376935346
Name:FOX, JEREMY GAITHER (LCMHC)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:GAITHER
Last Name:FOX
Suffix:
Gender:M
Credentials:LCMHC
Other - Prefix:
Other - First Name:JEREMY
Other - Middle Name:
Other - Last Name:FOX
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, LPCA, NCC
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1010 BETHESDA CT
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-3019
Practice Address - Country:US
Practice Address - Phone:336-277-6000
Practice Address - Fax:336-277-6001
Is Sole Proprietor?:No
Enumeration Date:2015-02-26
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA11357101YP2500X
NC11357101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional