| Doctor Name: | MR. CHARLES D FOX |
| NPI Number: | 1568798163 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | CADC-I |
| License Number: | 391180139 |
| Business Practice Address: | 3144 Vanzile Road Crandon, WI - 545208880 |
| Business Phone Number: | 7154785180 |
| Business Fax Number: | 7154785904 |
| Mailing Address: | 3144 Vanzile Road, CRANDON |
| State: | WI |
| Postal Code: | 545208880 |
| Phone Number: | 7154785180 |
| Fax Number: | 7154785904 |
| NPI Enumeration Date: | 11/02/2009 |
| NPI Last Update Date: | 11/03/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 391180139 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WI |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |