Provider Demographics
NPI:1134503220
Name:WILLIAM PAUL HIXSON
Entity Type:Organization
Organization Name:WILLIAM PAUL HIXSON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:HIXSON
Authorized Official - Suffix:
Authorized Official - Credentials:MED, LCSW-C
Authorized Official - Phone:301-648-6109
Mailing Address - Street 1:19601 SEYMOUR CT
Mailing Address - Street 2:
Mailing Address - City:POOLESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20837-2293
Mailing Address - Country:US
Mailing Address - Phone:301-648-6109
Mailing Address - Fax:
Practice Address - Street 1:19601 SEYMOUR CT
Practice Address - Street 2:
Practice Address - City:POOLESVILLE
Practice Address - State:MD
Practice Address - Zip Code:20837-2293
Practice Address - Country:US
Practice Address - Phone:301-648-6109
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-17
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD05376261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)