MEDICARE: SCOTT G. KIXMILLER MSW, LCSW, LCAS, CCS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	1890	NC
2	1041C0700X	Clinical Social Worker	C007896	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1669775318
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SCOTT G. KIXMILLER MSW, LCSW, LCAS, CCS

Provider Business Mailing Address
First Line	:	3755 ADMIRAL DR STE 105A
Second Line	:
City	:	HIGH POINT
State	:	NC
Zip	:	27265-1554
Country	:	US
Telephone Number	:	336-673-5097
Fax Number	:	336-203-3644

Provider Business Practice Location Address
First Line	:	3755 ADMIRAL DR STE 105A
Second Line	:
City	:	HIGH POINT
State	:	NC
Zip	:	27265-1554
Country	:	US
Telephone Number	:	336-673-5097
Fax Number	:	336-203-3644

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/17/2010
Last Update Date	:	08/03/2022

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