Provider Demographics
NPI:1669775318
Name:KIXMILLER, SCOTT G (MSW, LCSW, LCAS, CCS)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:G
Last Name:KIXMILLER
Suffix:
Gender:M
Credentials:MSW, LCSW, LCAS, CCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3755 ADMIRAL DR STE 105A
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27265-1554
Mailing Address - Country:US
Mailing Address - Phone:336-673-5097
Mailing Address - Fax:336-203-3644
Practice Address - Street 1:3755 ADMIRAL DR STE 105A
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27265-1554
Practice Address - Country:US
Practice Address - Phone:336-673-5097
Practice Address - Fax:336-203-3644
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-17
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1890101YA0400X
NCC0078961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6112277Medicaid
NCQ42663AMedicare UPIN