Provider Demographics
NPI:1649036906
Name:FOX, LAWRENCE (SOCIAL WORKER)
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:
Last Name:FOX
Suffix:
Gender:M
Credentials:SOCIAL WORKER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13215 SE MILL PLAIN BLVD
Mailing Address - Street 2:STE C8 #1028
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98684
Mailing Address - Country:US
Mailing Address - Phone:096-849-2047
Mailing Address - Fax:
Practice Address - Street 1:340 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:DE
Practice Address - Zip Code:19720-2542
Practice Address - Country:US
Practice Address - Phone:360-450-3644
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-26
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEEXEMPT24-3903C3104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker