Provider Demographics
NPI:1336340876
Name:FOX, JOHN MARSHALL (LPC)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:MARSHALL
Last Name:FOX
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11260 CHESTNUT GROVE SQ APT 340
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190-5150
Mailing Address - Country:US
Mailing Address - Phone:703-787-8672
Mailing Address - Fax:
Practice Address - Street 1:297 HERNDON PKWY STE 201
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-4468
Practice Address - Country:US
Practice Address - Phone:703-787-8526
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701003396101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional