Provider Demographics
NPI:1164266490
Name:NIXON, SARA C (RMHCI)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:C
Last Name:NIXON
Suffix:
Gender:F
Credentials:RMHCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:847 HIGHLAND AVE APT 202
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-3933
Mailing Address - Country:US
Mailing Address - Phone:317-361-3258
Mailing Address - Fax:
Practice Address - Street 1:50 LAKE MORTON DR
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33801-5343
Practice Address - Country:US
Practice Address - Phone:863-288-0821
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-21
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL21785101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health