Provider Demographics
NPI:1508984691
Name:FOX, ALDEANA (MA, CAC-M)
Entity Type:Individual
Prefix:MISS
First Name:ALDEANA
Middle Name:
Last Name:FOX
Suffix:
Gender:F
Credentials:MA, CAC-M
Other - Prefix:MS
Other - First Name:ALDEANA
Other - Middle Name:
Other - Last Name:FOX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CAC-M
Mailing Address - Street 1:5470 CHENE ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48211-2746
Mailing Address - Country:US
Mailing Address - Phone:313-875-5521
Mailing Address - Fax:313-267-0549
Practice Address - Street 1:5470 CHENE ST
Practice Address - Street 2:SUITE 100
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48211-2746
Practice Address - Country:US
Practice Address - Phone:313-875-5521
Practice Address - Fax:313-267-0549
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1-04482101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1891825805Medicaid