Provider Demographics
NPI:1609522002
Name:FOX, JENINE (MSW, LCSW-A)
Entity Type:Individual
Prefix:
First Name:JENINE
Middle Name:
Last Name:FOX
Suffix:
Gender:F
Credentials:MSW, LCSW-A
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 315
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27702-0315
Mailing Address - Country:US
Mailing Address - Phone:910-212-4441
Mailing Address - Fax:844-965-9504
Practice Address - Street 1:3500 WESTGATE DR STE 504
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-2568
Practice Address - Country:US
Practice Address - Phone:810-212-4441
Practice Address - Fax:844-965-9504
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-23
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0189701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical