Provider Demographics
NPI:1477342558
Name:NIXON, KANDICE MAKAYLA (T-CADC)
Entity type:Individual
Prefix:
First Name:KANDICE
Middle Name:MAKAYLA
Last Name:NIXON
Suffix:
Gender:F
Credentials:T-CADC
Other - Prefix:MRS
Other - First Name:KANDICE
Other - Middle Name:MAKAYLA
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NIXON, T-CADC
Mailing Address - Street 1:4710 CLARMAR RD
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40299-1005
Mailing Address - Country:US
Mailing Address - Phone:229-591-8422
Mailing Address - Fax:
Practice Address - Street 1:1700 CARGO CT
Practice Address - Street 2:
Practice Address - City:JEFFERSONTOWN
Practice Address - State:KY
Practice Address - Zip Code:40299-1938
Practice Address - Country:US
Practice Address - Phone:855-694-8288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-05
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY295178101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)