Provider Demographics
NPI:1649562844
Name:VERNON, ROBERT FOX (PHD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:FOX
Last Name:VERNON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108A S COLUMBUS ST
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22314-3051
Mailing Address - Country:US
Mailing Address - Phone:703-957-5778
Mailing Address - Fax:978-477-5634
Practice Address - Street 1:108A S COLUMBUS ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-3051
Practice Address - Country:US
Practice Address - Phone:703-957-5778
Practice Address - Fax:978-477-5634
Is Sole Proprietor?:No
Enumeration Date:2011-05-05
Last Update Date:2015-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
0810004608103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling