Provider Demographics
NPI:1669062170
Name:NIXON, KEISHA DUNNOM (LPC)
Entity type:Individual
Prefix:
First Name:KEISHA
Middle Name:DUNNOM
Last Name:NIXON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 BRAFIELD PL
Mailing Address - Street 2:
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063-9371
Mailing Address - Country:US
Mailing Address - Phone:803-973-2461
Mailing Address - Fax:803-455-6697
Practice Address - Street 1:210 BRAFIELD PL
Practice Address - Street 2:
Practice Address - City:IRMO
Practice Address - State:SC
Practice Address - Zip Code:29063-9371
Practice Address - Country:US
Practice Address - Phone:803-973-2461
Practice Address - Fax:803-455-6697
Is Sole Proprietor?:No
Enumeration Date:2021-01-20
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8604101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health