Provider Demographics
NPI:1659428258
Name:FOX, MARIE ANNETTE (LMSW)
Entity Type:Individual
Prefix:MS
First Name:MARIE
Middle Name:ANNETTE
Last Name:FOX
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29696 SPOON AVE
Mailing Address - Street 2:
Mailing Address - City:MADISON HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48071-4437
Mailing Address - Country:US
Mailing Address - Phone:985-688-0208
Mailing Address - Fax:866-656-1713
Practice Address - Street 1:2265 LIVERNOIS RD STE 260
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-1639
Practice Address - Country:US
Practice Address - Phone:248-906-0794
Practice Address - Fax:866-656-1713
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2020-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
MI68010831851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2165004OtherPTAN OR LEGACY NUMBER