Provider Demographics
NPI:1356472518
Name:FOX, BRETT ANTHONY
Entity type:Individual
Prefix:DR
First Name:BRETT
Middle Name:ANTHONY
Last Name:FOX
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:BRETT
Other - Middle Name:ANTHONY
Other - Last Name:FOX
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:3209 HIKING TRL
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-4008
Mailing Address - Country:US
Mailing Address - Phone:919-846-4070
Mailing Address - Fax:
Practice Address - Street 1:3209 HIKING TRL
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-4008
Practice Address - Country:US
Practice Address - Phone:919-946-4070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1559103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist