Provider Demographics
NPI:1528234648
Name:NIX, TIMOTHY SAWYER (MED, LPC)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:SAWYER
Last Name:NIX
Suffix:
Gender:M
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 RUNNING FOX LN
Mailing Address - Street 2:
Mailing Address - City:BELTON
Mailing Address - State:SC
Mailing Address - Zip Code:29627-8299
Mailing Address - Country:US
Mailing Address - Phone:864-706-3910
Mailing Address - Fax:
Practice Address - Street 1:218 TRIBBLE ST
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29625-4339
Practice Address - Country:US
Practice Address - Phone:864-642-1171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-08
Last Update Date:2020-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
SC5284101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1528234648Medicaid