Basic Information
| Provider Information | |||||||||
| NPI: | 1659854685 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FOX | ||||||||
| FirstName: | CHRISTINA | ||||||||
| MiddleName: | ALICIA | ||||||||
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| Credential: | LGSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10914 GEORGIA AVE APT 637 | ||||||||
| Address2: | |||||||||
| City: | SILVER SPRING | ||||||||
| State: | MD | ||||||||
| PostalCode: | 209024450 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7193146719 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 17904 GEORGIA AVE STE 200 | ||||||||
| Address2: | |||||||||
| City: | OLNEY | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208322277 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2403043327 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/14/2018 | ||||||||
| LastUpdateDate: | 09/14/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | LG50082516 | DC | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.