Provider Demographics
NPI:1538351747
Name:NIXON, BEVIN JOYCE (PHD, LCSW, LISW-CP)
Entity type:Individual
Prefix:
First Name:BEVIN
Middle Name:JOYCE
Last Name:NIXON
Suffix:
Gender:F
Credentials:PHD, LCSW, LISW-CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 HILLSBOROUGH DR
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:SC
Mailing Address - Zip Code:29526-7998
Mailing Address - Country:US
Mailing Address - Phone:609-474-0921
Mailing Address - Fax:609-269-1447
Practice Address - Street 1:801 12TH AVE S STE B
Practice Address - Street 2:
Practice Address - City:NORTH MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29582-3765
Practice Address - Country:US
Practice Address - Phone:843-663-0828
Practice Address - Fax:843-492-6766
Is Sole Proprietor?:No
Enumeration Date:2007-08-11
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW610730471041C0700X
NJ44SC052157001041C0700X
SC179291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSW1065Medicaid