Healthcare Provider Details

I. General information

NPI: 1205758687
Provider Name (Legal Business Name): CROWN & FOX LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12711 DAYBREAK CIR
NEWPORT NEWS VA
23602-9504
US

IV. Provider business mailing address

12711 DAYBREAK CIR
NEWPORT NEWS VA
23602-9504
US

V. Phone/Fax

Practice location:
  • Phone: 804-475-8129
  • Fax:
Mailing address:
  • Phone: 804-475-8129
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: CHARISMA DIXON
Title or Position: BEHAVIORAL HEALTH CONSULTANT
Credential: M.ED.,QMHP, CSAC
Phone: 804-475-8129