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General NPI Number Information
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NPI Number | 1316350465
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Entity Type | Individual
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Provider Name | LASHONDREA NIXON
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Gender | Male
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Dates
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Enumeration Date | 06/06/2014
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Last Update Date | 06/06/2014
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Provider Practice Location Address
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Address Line | 20 E TABB ST 207
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City | PETERSBURG
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State | VA
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Zip | 23803-4541
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Country | US
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Telephone | 336-575-7310
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Fax |
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Provider Business Mailing Address
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Address Line | 722 IVY GLEN DR
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City | WINSTON SALEM
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State | NC
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Zip | 27127-4065
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 2133
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License Number State | VA
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