Individual
LASHONDREA NIXON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
20 E TABB ST, 207, PETERSBURG, VA 23803-4541
(336) 575-7310
Mailing address
722 IVY GLEN DR, WINSTON SALEM, NC 27127-4065
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
2133
VA
Other
Enumeration date
06/06/2014
Last updated
06/06/2014
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