Provider Demographics
NPI:1285266841
Name:MIXSON, CHRISTY P (LPC-A)
Entity type:Individual
Prefix:
First Name:CHRISTY
Middle Name:P
Last Name:MIXSON
Suffix:
Gender:F
Credentials:LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 RIVERWALK BLVD STE H
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:SC
Mailing Address - Zip Code:29936-3252
Mailing Address - Country:US
Mailing Address - Phone:843-707-2198
Mailing Address - Fax:843-206-0256
Practice Address - Street 1:61 RIVERWALK BLVD STE H
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:SC
Practice Address - Zip Code:29936-3252
Practice Address - Country:US
Practice Address - Phone:843-707-2198
Practice Address - Fax:843-206-0256
Is Sole Proprietor?:No
Enumeration Date:2020-02-11
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7292101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional