Provider Demographics
NPI:1578077715
Name:BIXLER, NICOLE (LISW-CP)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:BIXLER
Suffix:
Gender:F
Credentials:LISW-CP
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:ATHENS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 547
Mailing Address - Street 2:
Mailing Address - City:LITTLE RIVER
Mailing Address - State:SC
Mailing Address - Zip Code:29566-0547
Mailing Address - Country:US
Mailing Address - Phone:843-663-8013
Mailing Address - Fax:
Practice Address - Street 1:1075 MR JOE WHITE AVE UNIT 101
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577-5658
Practice Address - Country:US
Practice Address - Phone:843-663-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-27
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00262300101YA0400X
1041C0700X
SC142841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)