Provider Demographics
NPI:1649474776
Name:FOX, CAROLYN MAY (MA COUNSELING)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:MAY
Last Name:FOX
Suffix:
Gender:F
Credentials:MA COUNSELING
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6 ACADEMY WAY
Mailing Address - Street 2:233
Mailing Address - City:ST. PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33711
Mailing Address - Country:US
Mailing Address - Phone:813-695-2633
Mailing Address - Fax:813-281-8955
Practice Address - Street 1:1408 N WEST SHORE BLVD
Practice Address - Street 2:SUITE 502
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-4525
Practice Address - Country:US
Practice Address - Phone:813-281-8955
Practice Address - Fax:813-281-2474
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLMH 1656101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health