Provider Demographics
NPI:1114307204
Name:NIX, LESTER CLINTON III (LCSW)
Entity Type:Individual
Prefix:
First Name:LESTER
Middle Name:CLINTON
Last Name:NIX
Suffix:III
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:CLINT
Other - Middle Name:
Other - Last Name:NIX
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:784 SILKWOOD CT
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-5929
Mailing Address - Country:US
Mailing Address - Phone:510-390-3279
Mailing Address - Fax:
Practice Address - Street 1:784 SILKWOOD CT
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-5929
Practice Address - Country:US
Practice Address - Phone:510-390-3279
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-03
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW125021041C0700X
CALCSW 165141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical