Provider Demographics
NPI:1447433933
Name:FOX, LETICIA HERNANDEZ (LMSW)
Entity type:Individual
Prefix:
First Name:LETICIA
Middle Name:HERNANDEZ
Last Name:FOX
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4646 CORONA DR STE 250
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-4395
Mailing Address - Country:US
Mailing Address - Phone:361-854-9961
Mailing Address - Fax:
Practice Address - Street 1:4646 CORONA DR STE 250
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-4395
Practice Address - Country:US
Practice Address - Phone:361-854-9961
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-07
Last Update Date:2010-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX100270104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker