Provider Demographics
NPI:1245606748
Name:FOX, MICHAELA HOLLY (LPA)
Entity type:Individual
Prefix:MRS
First Name:MICHAELA
Middle Name:HOLLY
Last Name:FOX
Suffix:
Gender:F
Credentials:LPA
Other - Prefix:MS
Other - First Name:MICHAELA
Other - Middle Name:HOLLY
Other - Last Name:PUTNAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:215 N 35TH ST STE 1
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28557-3186
Mailing Address - Country:US
Mailing Address - Phone:252-207-0545
Mailing Address - Fax:
Practice Address - Street 1:215 N 35TH ST STE 1
Practice Address - Street 2:
Practice Address - City:MOREHEAD CITY
Practice Address - State:NC
Practice Address - Zip Code:28557-3186
Practice Address - Country:US
Practice Address - Phone:252-207-0545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-19
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
247200000X
NC5865103T00000X
NCBACB360931103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst