Provider Demographics
NPI:1801822135
Name:LEONARD M. FOX, PH.D., P.A.
Entity Type:Organization
Organization Name:LEONARD M. FOX, PH.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:M
Authorized Official - Last Name:FOX
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:704-365-1979
Mailing Address - Street 1:6733 FAIRVIEW RD STE B
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-3652
Mailing Address - Country:US
Mailing Address - Phone:704-365-1979
Mailing Address - Fax:704-365-1979
Practice Address - Street 1:6733 FAIRVIEW RD STE B
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-3652
Practice Address - Country:US
Practice Address - Phone:704-365-1979
Practice Address - Fax:704-365-1979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-26
Last Update Date:2009-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC419103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty