Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | NV00191-LC | NV |
Y | 1041C0700X | Clinical Social Worker | NV 2105C | NV |
NPI | 1003853813 |
---|---|
Provider Name | Sandie W Fox |
First Address | Reno, NV 89509-1527 |
Second Address | Reno, NV 89509-1527 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2006 |
Last Update Date | 16/09/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100508118 | (05) | NV |
GC313A | (02) | NV |