Provider Demographics
NPI:1891488466
Name:NIXON, KANON
Entity type:Individual
Prefix:
First Name:KANON
Middle Name:
Last Name:NIXON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:380 CARATOKE HWY
Mailing Address - Street 2:
Mailing Address - City:MOYOCK
Mailing Address - State:NC
Mailing Address - Zip Code:27958-8623
Mailing Address - Country:US
Mailing Address - Phone:252-232-8086
Mailing Address - Fax:252-232-9136
Practice Address - Street 1:380 CARATOKE HWY
Practice Address - Street 2:
Practice Address - City:MOYOCK
Practice Address - State:NC
Practice Address - Zip Code:27958-8623
Practice Address - Country:US
Practice Address - Phone:252-232-8086
Practice Address - Fax:252-232-9136
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-31
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA18900101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health