Provider Demographics
NPI:1194220996
Name:HIXSON, THERESA L (LCSW)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:L
Last Name:HIXSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 SIMSBURY RD. 9B
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:CT
Mailing Address - Zip Code:06001
Mailing Address - Country:US
Mailing Address - Phone:860-604-6609
Mailing Address - Fax:860-228-1213
Practice Address - Street 1:152 SIMSBURY RD.
Practice Address - Street 2:BUILDING 9
Practice Address - City:AVON
Practice Address - State:CT
Practice Address - Zip Code:06001
Practice Address - Country:US
Practice Address - Phone:860-604-6609
Practice Address - Fax:860-228-1213
Is Sole Proprietor?:No
Enumeration Date:2018-03-26
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0049861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical