Provider Demographics
NPI:1194047605
Name:FOX, JOHN IV (LCSW)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:FOX
Suffix:IV
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:JOHNNY
Other - Middle Name:
Other - Last Name:FOX
Other - Suffix:IV
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:78-7070 ALII DRIVE A301
Mailing Address - Street 2:
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96740
Mailing Address - Country:US
Mailing Address - Phone:804-914-4472
Mailing Address - Fax:
Practice Address - Street 1:78-7070 ALII DRIVE A301
Practice Address - Street 2:
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740
Practice Address - Country:US
Practice Address - Phone:804-914-4472
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-25
Last Update Date:2013-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI38291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical