Provider Demographics
NPI:1720556731
Name:HIXSON, JOHN BENJAMIN (LPC)
Entity Type:Individual
Prefix:
First Name:JOHN BENJAMIN
Middle Name:
Last Name:HIXSON
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:776 OXFORD CT SW
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-6563
Mailing Address - Country:US
Mailing Address - Phone:770-846-3220
Mailing Address - Fax:
Practice Address - Street 1:270 W OAK ST STE 2
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-4813
Practice Address - Country:US
Practice Address - Phone:770-846-3220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-07
Last Update Date:2021-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC010122101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional