Provider Demographics
NPI:1083126221
Name:NIXON, KEVANA M (LMFT)
Entity Type:Individual
Prefix:
First Name:KEVANA
Middle Name:M
Last Name:NIXON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4524 OSAGE AVE APT 3R
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19143-2134
Mailing Address - Country:US
Mailing Address - Phone:615-618-1833
Mailing Address - Fax:
Practice Address - Street 1:261 CHAPMAN RD
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19702-5423
Practice Address - Country:US
Practice Address - Phone:302-455-9333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-27
Last Update Date:2017-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMF000957106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist