Provider Demographics
NPI:1790562460
Name:FOX, ASHLY RENEE (CADC-1, C-IAYT)
Entity Type:Individual
Prefix:
First Name:ASHLY
Middle Name:RENEE
Last Name:FOX
Suffix:
Gender:F
Credentials:CADC-1, C-IAYT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:721 VIA OTONO
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92672-6020
Mailing Address - Country:US
Mailing Address - Phone:949-310-3722
Mailing Address - Fax:
Practice Address - Street 1:1400 REYNOLDS AVE STE 102
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92614-5562
Practice Address - Country:US
Practice Address - Phone:949-393-2240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-14
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YA0400X, 171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171400000XOther Service ProvidersHealth & Wellness CoachGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)