Provider Demographics
NPI:1386191187
Name:HIXON, KELLIE (LCSW)
Entity Type:Individual
Prefix:
First Name:KELLIE
Middle Name:
Last Name:HIXON
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 1:209 MAGNOLIA TER
Mailing Address - Street 2:UNIT B
Mailing Address - City:UPPER DARBY
Mailing Address - State:PA
Mailing Address - Zip Code:19082-1014
Mailing Address - Country:US
Mailing Address - Phone:609-668-4021
Mailing Address - Fax:
Practice Address - Street 1:850 N 11TH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19123-1957
Practice Address - Country:US
Practice Address - Phone:215-769-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-09
Last Update Date:2018-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW1306911041C0700X
PACW0197901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical