Provider Demographics
NPI:1154863116
Name:NIXON, DAVID MANN (LCSW, DMHP)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:MANN
Last Name:NIXON
Suffix:
Gender:M
Credentials:LCSW, DMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3285 FERGUSON ST SW
Mailing Address - Street 2:
Mailing Address - City:TUMWATER
Mailing Address - State:WA
Mailing Address - Zip Code:98512-6192
Mailing Address - Country:US
Mailing Address - Phone:360-943-1907
Mailing Address - Fax:360-943-1912
Practice Address - Street 1:2690 NE KRESKY AVE
Practice Address - Street 2:
Practice Address - City:CHEHALIS
Practice Address - State:WA
Practice Address - Zip Code:98532
Practice Address - Country:US
Practice Address - Phone:360-330-9595
Practice Address - Fax:360-330-9560
Is Sole Proprietor?:No
Enumeration Date:2016-11-08
Last Update Date:2018-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA604926621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical