Provider Demographics
NPI:1922702117
Name:FOX, VANESSA (RESIDENT COUNSELOR)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:FOX
Suffix:
Gender:F
Credentials:RESIDENT COUNSELOR
Other - Prefix:
Other - First Name:VANESSA
Other - Middle Name:
Other - Last Name:KASZUBOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11452 WARDS RD
Mailing Address - Street 2:
Mailing Address - City:RUSTBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24588-2528
Mailing Address - Country:US
Mailing Address - Phone:540-466-3007
Mailing Address - Fax:
Practice Address - Street 1:82 ENGLISH TAVERN RD.
Practice Address - Street 2:
Practice Address - City:RUSTBURG
Practice Address - State:VA
Practice Address - Zip Code:24588
Practice Address - Country:US
Practice Address - Phone:540-466-3007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-30
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0704015725101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health