MEDICARE: MR. ROBERT MANNING NIX M.ED.

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	101YP2500X	Professional Counselor	1555	SC

General Provider Information

NPI Number	:	1316970213
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROBERT MANNING NIX M.ED.

Provider Business Mailing Address
First Line	:	1 CARRIAGE LN STE J
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29407-6060
Country	:	US
Telephone Number	:	843-452-6498
Fax Number	:	843-573-5030

Provider Business Practice Location Address
First Line	:	1 CARRIAGE LN STE J
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29407-6060
Country	:	US
Telephone Number	:	843-452-6498
Fax Number	:	843-573-5030

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

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	07/08/2007

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