Provider Demographics
NPI:1578016010
Name:NIX, ERICA STACY
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:STACY
Last Name:NIX
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ERICA
Other - Middle Name:
Other - Last Name:NIX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:633 THORNBIRD CIR
Mailing Address - Street 2:
Mailing Address - City:BOILING SPRINGS
Mailing Address - State:SC
Mailing Address - Zip Code:29316-5364
Mailing Address - Country:US
Mailing Address - Phone:864-516-2684
Mailing Address - Fax:
Practice Address - Street 1:633 THORNBIRD CIR
Practice Address - Street 2:
Practice Address - City:BOILING SPRINGS
Practice Address - State:SC
Practice Address - Zip Code:29316-5364
Practice Address - Country:US
Practice Address - Phone:864-516-2684
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-02
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1-19-34653103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1-19-34653OtherBACB