Provider Demographics
NPI:1902163660
Name:NIXON, ANGEANETTE MCCALL (LPC)
Entity Type:Individual
Prefix:MRS
First Name:ANGEANETTE
Middle Name:MCCALL
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:PO BOX 1613
Mailing Address - Street 2:
Mailing Address - City:TIFTON
Mailing Address - State:GA
Mailing Address - Zip Code:31793-1613
Mailing Address - Country:US
Mailing Address - Phone:229-339-3721
Mailing Address - Fax:229-472-9151
Practice Address - Street 1:223 2ND ST E
Practice Address - Street 2:SUITE B
Practice Address - City:TIFTON
Practice Address - State:GA
Practice Address - Zip Code:31794-4493
Practice Address - Country:US
Practice Address - Phone:229-339-3721
Practice Address - Fax:229-472-9151
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-19
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA006795101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA006795Other006795