Provider Demographics
NPI:1376125294
Name:FOX, ABIGAIL
Entity type:Individual
Prefix:MRS
First Name:ABIGAIL
Middle Name:
Last Name:FOX
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2119 GARABRANDT LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204-2553
Mailing Address - Country:US
Mailing Address - Phone:980-428-9680
Mailing Address - Fax:980-217-4001
Practice Address - Street 1:212 E TREMONT AVE STE C
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-5363
Practice Address - Country:US
Practice Address - Phone:980-428-9680
Practice Address - Fax:980-217-4001
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-21
Last Update Date:2024-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
OHC.2103370101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health