Individual
BETHANY L NIXON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
4043 FAIRFAX ST, AUGUSTA, GA 30907-2190
(706) 399-4579
Mailing address
4043 FAIRFAX ST, AUGUSTA, GA 30907-2190
(706) 399-4579
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
LPC010879
GA
101YA0400X
Addiction (Substance Use Disorder) Counselor
LPC010879
GA
101YM0800X
Mental Health Counselor
Primary
LPC010879
GA
Other
Enumeration date
04/16/2019
Last updated
04/16/2019
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